A spinal anaesthetic (sometimes called a spinal for short) is when medicine is injected with a small needle into the fluid around the spinal cord which makes the nerves go numb. After this, your baby cannot feel anything from the waist to the toes for the next one to two hours. The medicine does not go into the actual spinal cord.

Spinal anaesthetics are commonly used by women having a baby by caesarean section and by older people having surgery. During the operation your baby will be awake and have a dummy dipped in sugar solution to suck. Many babies feel so warm and comfortable that they fall asleep.

Why should my baby have a spinal anaesthetic?

Your anaesthetist may choose to give a spinal anaesthetic to babies born early (premature or prem babies) in preference to a general anaesthetic (GA). A GA can affect their breathing, in particular, make it more likely to have breath holding episodes or apnoea’s. Babies having a spinal anaesthetic are less likely to have apnoea’s.

Your baby may still need a general anaesthetic if:

• There is an infection, or your baby has bleeding problems.
• The spinal anaesthetic does not work as well as it should.
• The surgery takes longer or is more complicated than expected.

Whether your baby has a spinal or general anaesthetic, nurses and doctors watch them carefully in case there are any complications. 

For and against spinal anaesthetic

At The Royal Children's Hospital there are more than 300 hernia repair operations done every year in babies less than one month old. Many of these are done with a spinal anaesthetic.

There may be less chance of having irregular breathing patterns after surgery with a spinal anaesthetic.  There are other benefits as well:

• The spinal block stops your baby feeling pain after the operation for up to 2 hours
• Because they are not sedated, babies are more awake after surgery
• Most babies can feed soon after having surgery because they are awake.
• Modern anaesthesia is very safe, and it is rare to have complications.
  

Common side effects:

• Babies may have some reduced movement of their legs for one to two hours. This is normal after a spinal anaesthetic.
  

Rare side effects:

• Nerve damage. This is a very rare complication of spinal anaesthesia. Some loss of feeling may last for a few weeks, but it almost always improves.
• Infection at the place of the injection. Extremely rarely, the spinal injection may be associated with meningitis if the surgery is done when the child is already unwell.

After the operation

If your baby is still premature or less than six weeks old, they will probably stay in hospital for a night after the surgery. When the spinal wears off your baby may have some pain so they will be given some pain relief medicine such as paracetamol for the first night.

See a doctor if your baby:

If your baby has any of the following within 48 hours (two days) after their operation:

• Has a temperature of 38ºC or higher. Mild fever after surgery is common but should be less than 37.5ºC.
• Cries constantly or you cannot settle them.
• Seems to have no energy (lethargic).
• Is not moving their legs normally
• If it is difficult to interact with them - i.e., you cannot get their attention.
• If it is difficult to wake them or they cannot stop crying (inconsolable).
• Keeps vomiting or will not feed.
• Seems to have pain that does not get better with pain medicine.
• Has a lot of redness or swelling around the wound (contact the surgeon) or around the area of the injection (contact the anaesthetist).
• Has any other symptoms causing you concern.
  

Follow-up

• Stitches are dissolvable so they do not need to be removed.
• Your baby will need a follow-up appointment in about seven to 10 days after the operation to check the wound has healed well. This could be with the surgeon, your family GP or paediatrician, depending on where you live and how convenient it is for you to return to the RCH.
• A nurse or doctor will discuss this with you before you leave the hospital.
• If you have any concerns before the appointment, see your family doctor or paediatrician first. They will call the hospital if necessary.
  

Key points to remember

• A spinal anaesthetic is often used in preference to a general anaesthetic in very premature babies.
• Spinal anaesthesia is usually used for repair of hernias. Baby hernias are very common in very premature babies.
• If you have any concerns in the first two days after the operation, call The Royal Children's Hospital on (03) 9345 5522.
• If you have any concerns several days after the operation, see your family GP or paediatrician who can call the hospital if necessary.
  

Contact details

• The Royal Children's Hospital
  T: (03) 9345 5522 (switchboard)
  Ask to speak to the surgical fellow on call. 

  • If you cannot speak to them, ask for the anaesthetist registrar on call.
  • If you are very concerned, take your child to your nearest hospital or RCH Emergency Department.

For more information

• The RCH website on pain control and anaesthetics has information for parents and children on having anaesthetics
  http://www.rch.org.au/anaes
  
• The website for the Australian and New Zealand College of Anaesthetists.  (For medical professionals)
  http://www.anzca.edu.au
  
• The Australian Society of Anaesthetists Pty. (For medical professionals)
  www.asa.org.au 
  
  
  Talk to your family doctor

Individual information

Your surgeon is:       ____________________________________

Your anaesthetist is: ____________________________________