Rationale for spinal anesthesia

Abstract

Spinal anesthesia is probably the most widely used form of regional anesthesia today. A number of clinical studies suggest that spinal anesthesia may be superior to general or epidural anesthesia for certain patients and for certain surgical procedures. The endocrine-metabolic response to surgery appears to be blunted when spinal anesthesia is employed compared to the response during general anesthesia. Blood loss and thromboembolic complications are also reduced when spinal anesthesia is used, particularly for major lower limb orthopedic procedures. Although long-term survival is not affected by the anesthetic technique employed, short-term mortality may be decreased in elderly patients having major orthopedic surgery under spinal anesthesia. Compared to epidural blockade, spinal anesthesia provides a more rapid onset, a more predictable level of analgesia, and a more profound degree of surgical anesthesia. On the other hand, spinal anesthesia is associated with a greater degree of hypotension compared to epidural anesthesia. The results of these various investigations show that a scientific rationale exists for the continued use of spinal anesthesia.