What is meant by late effects
Late complications are side effects that persist beyond the immediate period of the procedure. Since many side effects can occur during spinal anesthesia, which subside within a few days, these are not considered to be late effects. Only if symptoms persist after weeks or months are they late effects. These are significantly less common than normal side effects, but offer great limitations and pain for those affected.
What are the late effects?
The late effects of spinal anesthesia increase the direct side effects and remain for a longer period of time. The most common side effects, which can persist for a long time, are headaches and nausea. In addition, dizziness may also last longer.
With the headaches, which are often caused by the loss of cerebral fluid, neck stiffness can occur. Some sufferers also suffer from incontinence or urinary retention because the nerves that control the bladder can be irritated. The puncture can cause bruising or swelling, which puts pressure on these and other nerves.
Those affected have similar symptoms to a herniated disc with pain radiating into the legs. In rare cases, the puncture site can develop an infection with involvement of the meninges. Such meningitis can have serious consequences.
Furthermore, the development of an allergy to the anaesthetics is possible, which can cause difficulties if a new spinal anaesthesia is administered. Our brain and spinal cord are floating in a liquid called cerebrospinal fluid. This fluid is located between the spinal cord and meninges.
During a spinal anaesthesia, the outer meninges are punctured and the anaesthetic is injected into the spinal canal. During this process, a little cerebral fluid always escapes. Since the amount of cerebral fluid is very precisely adjusted, even the loss of this small amount leads to headaches.
Normally, the hole in this skin closes automatically after the needle is removed. However, in some patients, an opening remains and brain water continues to leak out. In this case, the headaches also persist.
People with certain pre-existing conditions, such as Marfan syndrome, are particularly often affected. Other symptoms are dizziness and neck stiffness. Spinal anesthesia is not the only reason for a cerebrospinal fluid loss syndrome.
A so-called blood patch is suitable as a treatment for many affected patients. Here, the body’s own blood is injected at the site of the opening, thus closing the opening. In some cases, surgery is also necessary.
Between the individual vertebral bodies, the spinal cord releases the individual nerves for different parts of the body. The first piece of these nerves is called the nerve root. During a spinal anaesthesia, nerves are only very rarely injured directly, but a subsequent irritation due to a haematoma can occur.
There is only a very limited space in the spinal canal in which a bruise can spread, which is why pressure can quickly build up on the nerves. The symptoms here are the same as for a herniated disc. Those affected suffer from severe back pain that extends into the legs.
If the cause is a bruise, the nerves usually recover as soon as the pressure is removed. Only in rare cases do the symptoms persist. This happens especially when the pressure has been maintained too long and the nerves are permanently damaged.
Another cause of nerve root irritation during spinal anesthesia can be an abscess at the injection site. The symptoms are the same, but the treatment is more important because it can be a bacterial inflammation and ascending to meninges must be avoided. More about this complication under nerve root irritation