Back in 1962 I had an operation for a torn meniscus. The doc gave me a spinal, and after a few minutes, I felt that I couldn`t breathe and started panicking and then the docs put me out under general anesthesia. Now, I am scheduled to have a TURP, and the doc wants to give me a spinal again as the doc says she needs to be able to talk to me during the procedure. I am deathly afraid of getting the "not being able to breathe" problem again. I suppose the problem stems from the fact that I couldn`t move my lower adominal muscles during the procedure in 1962, which caused me to feel like I couldn`t breathe. Have things improved since 1962 as far as spinals go, or do I stand a chance of having the same problem again? If so, is there anything I can do to avoid the problem? 

Although it's 44 years ago this unpleasant experience is still vivid in your mind. In 1962 I was still in diapers. You were probably a young, active person and injured your knee playing hockey, skiing or on the football field. I would like to tell you that spinal anesthesia has changed radically since then. But it hasn't changed all that much. We still "stick" a needle (gently, of course) in your lower back and inject a small quantity of local anesthetic. Most of the local anesthetics we use today (lidocaine, bupivacaine) have been around for a good 30 to 40 years. 

What has changed is the size of the needle - much more delicate, narrow gauge needles are used today which minimize the risk of a postoperative headache. Monitoring has greatly improved, along with awareness of potential complications, allowing their prevention and/or early detection and treatment. 

What may be more important is that you have changed. You are older, probably wiser, and I would imagine a bit calmer in the face of adversity. As a more mature person you will probably be able to tolerate the unusual sensation of spinal blockade without panicking. If you are still extremely nervous, your anesthesia practitioner can offer you intravenous sedation along with the spinal. The sedative drugs available today have improved since 1962. They can provide you with a pleasant and tolerable experience. 

Finally, although spinal anesthesia is commonly used for TURP procedures it is not considered essential under normal circumstances. If you cannot face the prospect, please chat with your surgeon and your anesthesiologist ahead of time to make this clear to them and to allow consideration of the safe alternative - general anesthesia. 

I recently had a spinal tap because I had an emergency c-section. I was wandering if the pain I`m feeling around the injection site has anything to do with the spinal? 

A certain amount of discomfort around the injection site of a spinal anesthetic is quite common, but should improve quickly over a few days. The pain should be localized, with perhaps a bit of tenderness. If the anesthesiologist had to insert the needle in more than one site, or had more than one attempt to insert it, you may have more pain than usual. If the pain increases or is accompanied by redness, warmth, swelling, or a discharge you should immediately seek attention. These are signs of inflammation or infection. 

Back pain during pregnancy and after delivery is extremely common, occurring in at least 50% of cases. Sometimes the backache is attributed to the spinal anesthetic, but it is likely that in most cases there is no relation between the two. Such a backache would not be limited to the injection site of course. 

My doctor and I have scheduled my c-section. I have one previous c-section, then a VBAC, and now I have opted for another c-section & tubal ligation. My previous C-sec was emergency and was done with an epidural. My doctor wants to perform this c-sec with BOTH an epidural AND a spinal. Is this necessary? Is this routine? What are the advantages to doing both vrs. one or the other? 

Decisions about your anesthetic are usually made together with your anesthesiologist, and with input from your surgeon. I am sure you will have an opportunity to talk with them about the different techniques prior to your C-section. 

The effects of spinal and epidural anesthetics are quite similar but there are certain differences. Your anesthesiologist may explain that a spinal anesthetic comes on more quickly than an epidural and produces a more "dense" block. Both movement and sensation are reduced in your trunk (abdomen, back) and legs. The increased degree of motor (movement) block is not really useful for a cesarean section. But the sensory block (numbness) means that you feel less of the pulling and tugging as the doctor delivers the baby and sews you up. 

With a spinal anesthetic the drop of blood pressure that is commonly seen with both types of anesthetic is usually more significant. The blood pressure drop, which sometimes is associated with an unpleasant feeling of nausea, is definitely unwanted but quite easy to reverse if it does occur. 

As you have realized, a combined spinal-epidural (CSE) anesthetic is not "necessary". However, in some centers it has become routine. Why? Well, because the spinal anesthetic comes on much quicker than an epidural, the anesthetic can be established within a few minutes and the surgery can commence very soon thereafter. With the CSE technique an epidural catheter is placed at the same time. The epidural catheter can then be used to "top-up" the anesthetic and, if left in place, can also be used to give you pain relief after your operation for a day or two. By contrast, with an epidural anesthetic the onset is much more gradual and it takes about 10 - 15 minutes to get the anesthetic established to the point where the surgery can begin. 

Advocates of CSE say you are getting the best of both worlds. You get the rapid, somewhat deeper, and perhaps more reliable anesthetic of a spinal, together with postoperative analgesia of the epidural. 

Are there any problems with this approach? CSE started to become popular about 10 years ago with the introduction of special needles that allow doctors to perform both types of anesthetic through a single needle. Since that time, clinical studies seem to show about the same rate of side-effects and rare complications as the single (spinal or epidural) procedure by itself. 

Checking dermatome levels for epidural infusions : what should be used to test the sensory level? Touch, alcohol wipe or ice. Thanks. 

"Checking dermatome levels" usually refers to the technique used to estimate the extent of a spinal or epidural block. Dermatomes are the areas on the body surface associated with innervation, or supply by a particular nerve. 

An anesthesiologist will check the level of the block to make sure that anesthesia - the loss of pain sensation - is present in the area of the body where the surgery will take place. The level can be most easily checked using one of three different kinds of stimulation -light touch, cold or pinprick. These sensations are carried by three different types of nerve fiber. A beta fibers transmit touch, A delta fibers carry pinprick sensation, and C fibers are associated with the sensation of cold. Loss of tolerance of surgical anesthesia corresponds with the return of A beta function. This suggests that loss of light touch sensation may be the best indicator of surgical anesthesia in a particular dermatome. 

In the institution where I practice, dermatomal testing is usually done with an instrument that delivers a pricking sensation that does not penetrate the skin, such as the tip of a plastic needle, or, occasionally, with a disposable alcohol "wipe" or a piece of ice. Although this technique may not have the best scientific validation, in practice it works very well. 

Because of severe post-op nausea and vomiting with prior surgeries, it has been recommended that I have a spinal with no sedation for an upcoming transvaginal sling surgery, and possible DNC. I have read some articles that say there are a number of times where the spinal "fails", i.e., does not provide pain relief. Is this common? I`m very nervous. Thank you for your help. 

It's not common, but does occur very occasionally. However, you can be sure that your surgeons will not commence the surgery unless the spinal anesthetic is really working. The days of the Civil War are over!! If it is not working, the spinal block can be repeated, orﾠyou can get a general anesthetic at that stage. If, as expected, your spinal anesthetic is successful, you may not need any sedation. However the majority of patients request, and are given, some form of intravenous sedation to achieve greater comfort. Minimal or moderate sedation with modern anesthetic and sedative agents like propofol and midazolam is very unlikely to make you nauseous after the surgery. 

My niece had a child last night and had an epidural, last night around 8:00pm. One of her legs is paralyzed. She can feel her foot and her hip, but nothing in between. She cannot stand, she immediately falls when she tries. Is this a long term problem, or will it correct itself? 

ﾠI hope your niece's leg has recovered. Weakness is a normal feature of epidural anesthesia or analgesia. Sometimes the weakness can take several hours to disappear. The time for recovery depends on the dose and type of local anesthetic used. It may also depend on the site of the epidural catheter - catheters that end up close to a particular nerve root may result in disproportionate weakness or numbness in the distribution of that nerve. Sometimes the distribution seems strange because nerve roots supply sensation to defined areas of the leg. The legs are supplied, in part, by L4 and L5, and the foot by S1. 

When the effects of an epidural persists there is always a concern that a nerve has been injured. Such injuries, although uncommon, do occur. In most cases, the effects are transient, and full recovery occurs over a few weeks. Permanent nerve injuries are rare. 

It should be noted that although epidurals can result in nerve injury, the majority of nerve injuries in obstetrical patients are due to birth trauma. That is the effect of the baby's head coming through the birth canal, compressing the lumbar plexus. This type of injury normally heals. 

The most feared complication of an epidural is a hematoma (blood clot) in the spinal canal. A hematoma here can compress the spinal cord, decreasing its blood supply, and causing, over the course of 6-8 hours or so, permanent nerve injury. This type of problem often presents with back pain and loss of sensation and movement in both legs. Rapid treatment with surgery will save the spinal cord. I hasten to add that this complication of epidural anesthesia is rare, and can occur spontaneously in people who have not even had an epidural. 

This is not an emergency service, so if you have immediate concerns about anesthesia-related problems you must consult your doctor. Diagnosis of the cause of weakness or numbness requires a full history, physical examination, and, sometimes, X-Rays, CT or MRI scans, or direct testing of nerves and muscles. 

Eighteen months ago, I had an epidural. During the procedure, I experienced electrifying pain down my right leg numerous times. At one point, my pelvic floor felt like I was sitting on flames. Since this procedure, I have had paresthesias down my right leg and oddly in my rectum (sphincter muscle). Several months ago, I was given antidepressants to calm those nerves, but I have experienced unwanted side effects. I no longer want to take antidepressants for this problem and recently stopped them all together. The drugs helped to the point I didn`t have the sensations much at all, but now that I have stopped the meds, the nerve sensations are back with much frequency. The hospital where this happened is telling me that they have never had a case like this before and really have never heard of such symptoms, especially lasting 18 months. I really need some information on this issue. I would like to know what nerve may have been damaged, how long to expect healing (if at all) and other options for treatment. Any help would be greatly appreciated. Thanks. 

Thanks for your question. This must be a very difficult problem for you to deal with. 

I am not an expert on nerve injuries but I understand that most nerve injuries from direct needle trauma such as you have described are expected to heal in less than eighteen months. Beyond generalities, it is very difficult to provide useful advice in a case such as yours without the results of a comprehensive physical examination and appropriate laboratory tests. 

Although your history suggests that it was the epidural that injured certain nerves, or nerve roots, there may be other factors involved. These can include systemic conditions such as diabetes or nutritional problems, or local conditions in the spinal canal. Some, perhaps the majority, of nerve injuries after childbirth are due to "brith trauma" with the baby's head pressing on nerve structures in the pelvis. 

You should really seek expert help from a neurologist, and preferably from someone who has had experience diagnosing and treating nerve injuries. 

What is epidural anesthesia? 

ﾠEpidural anesthesia is a form of anesthesia in which a very narrow tube, (also called a catheter) is placed in the epidural space in your back. This space is within the spinal canal, but away from the spinal cord itself. Anesthetic medication is then injected into the space using the catheter. 

Epidural anesthesia temporarily blocks sensation, so that pain is not felt. Epidural anesthesia may also decrease the ability to move your legs, or even cause complete (but temporary) paralysis of your lower body. As the medication wears off, you will recover both sensation and movement. 

This form of anesthesia is useful for many types of surgical procedures on the lower extremity and the abdomen, including cesarean section, and orthopedic surgery on the knee or hip. 

Patients often ask whether they have to be awake for an epidural anesthetic. The answer, usually, is "not unless you wish to be!" Once the anesthetic is established your anesthesiologist will usually be happy to give you enough intravenous sedative medication to make you quite sleepy, and unaware of what`s going on. 

For insertion of an epidural, the adult patient is usually required to be awake, or just mildly sedated. This is because your cooperation enables the procedure to be performed safely and expeditiously. We will usually have the patient sit up, supported by an assistant, for the procedure. We also need to make sure that the anesthesia has reached an appropriate level before beginning the surgery and so will check that the anesthetic has taken effect (of course) before beginning the operation itself. 

I will be undergoing gallbladder removal. I have had a tonsilectomy, with no complications due to anesthesia except nausea. However when I had an epidural during childbirth, my pulse rate shot up, and the process was delayed a few minutes. Is that something that may happen with general anesthesia, or is that particular to an epidural? 

ﾠThanks for your question. Unfortunately it is not exactly clear from your description what happened to you when you received your epidural. Epidural analgesia for childbirth is not usually associated with an increased heart rate. One exception is when epidural medication, which may contain a small amount of epinephrine (adrenaline), is absorbed into the bloodstream from an epidural catheter whose tip is in or adjacent to an epidural vein. In that case the epidural catheter is usually removed and reinserted at another site. 

An increased pulse rate is, of course, very common during labor, because of pain and other factors. When an epidural is inserted your anesthesiologist monitors your heart rate and blood pressure more intensively than at other times. The heart rate increase may have had nothing at all to do with the epidural, which has an excellent safety record and is the most effective form of pain relief offered to women in childbirth. General anesthesia is an entirely different technique, using other drugs and equipment and associated with a different set of risks, including nausea. 

How do you test a patient to see if the epidural works before c-section? I recently had a c/section. I was told that the epidural failed so I had to have general anesthesia even though I had no feeling from the umbilicus. I did not have any pain from the contractions which I could not feel at all during labor or during pushings. In the OR the anesthesiologist used an object to touch my abdomen. I could not feel any thing at or below, but I can feel the touch above the umbilicus. And for that it was concluded the epidural failed. I had a ltcs, would the epidural be sufficent. The epidural site was at L3/4, so would it be expected that my skin above the umbilicus to be numbed while the dermatome of that region is supplied by lower thoracic branches. Thank you for your insights. 

To provide adequate anesthesia an epidural should produce a sensory level to approximately the T6 dermatome. That means sensation is blocked up to the area just beneath the breastbone. There are a variety of different methods of testing. Common methods include the use of an alcohol spray (very cold), or a pin (sharp). The idea is to stimulate a normal (unblocked) area of skin so the patient understands what the "normal" stimulation feels like, then try to define the area in which sensation is blocked. Blocked is actually a relative term. Most of the time, an epidural does not completely eliminate all forms of sensation, and pressure or movement are often still perceived. 

The umbilicus corresponds to a T10 level and may not be sufficient for a c-section. If you have a good T10 level, the block can almost always be extended by administering more anesthetic into the epidural catheter, and waiting a few minutes. 

The ultimate "test" of an epidural is whether the patient can tolerate the incision of the skin and the subsequent surgery. Most surgeons will do a final check by pinching the skin at the incision site with a surgical clamp. This would make anyone without a good anesthetic really jump! An epidural that works well during labor usually works well for a cesarian section. But not always! The catheter can become dislodged. 

Three years ago I had surgery for removal of a large ovarian cyst. An epidural was planned, and when I was prepped and on the OR table, leaning over as the needle was being inserted, I felt an electrical-like jolt of pain-(severe!!!!!), and I remember falling over on my side onto the table but that`s all. Next thing I remember I was waking up in recovery. Apparently after this happened a general anesthetic was administered instead, but next day there were large bruises on my left upper arm almost in the shape of fingerprints, as if I was grabbed to prevent falling off the table. My question is, is this common and what likely happened during the epidural? 

ﾠThe best way to establish what happened while you were in the operating room is to ask the doctors who took care of you. Failing that, you could ask to review the hospital records, which is your right. (Some institutions may charge for the cost of copying those records, which is their right!) 

One possibility is that the epidural needle went somewhere it was not intended to go. A very sharp, severe pain might have been due to contact between the needle, and a nerve. In such circumstances, the anesthesiologist would promptly withdraw the needle and he or she might very well choose to abandon the epidural and not subject the patient to further unintended pain or trauma. A general anesthetic is then a satisfactory alternative. 

How common is this? Unfortunately even in the best hands, regional anesthesia (including spinal and epidural) is occasionally unsuccessful. That's why there is always a "Plan B". 

The exact incidence of nerve injury in association with spinals or epidurals is of the order of one in every several thousand, with almost all of those recovering over a period of weeks to months. Epidurals are almost always done in awake patients. You might be able to guess why. Had you been asleep during the insertion of the needle you would not have reacted to the needle. Pain, and the reaction to pain allow the anesthesiologist to recognize the possibility of imminent injury to a nerve or other structure, withdraw the needle, and avoid serious harm. 

Although the marks on your upper arm might have resembled fingerprints, they were more likely due to the imprint of the blood pressure cuff. During a surgical procedure you will have your blood pressure measured repeatedly every 2-5 minutes. This sometimes causes bruising. 

I have had a previous c-section with a spinal anaesthesia, of which I had a reaction causing nerve loss in my lower back region. The Neurologist advised me not to have another spinal. If I have another c-section under general anaesthesia what risks might I face? Thank you. 

In most circumstances general anesthesia poses higher risk to mother and baby than spinal or epidural anesthesia. This is why spinal and epidural anesthesia have replaced general anesthesia as the technique of choice for cesarean section for most patients. In view of your previous complications from a spinal anesthetic however, general anesthesia could be the best choice for YOU. 

The determination of whether a spinal anesthetic has caused a neurologic complication is not always straightforward because childbirth and labor can themselves cause neurologic problems, and because neurologic problems unrelated to the anesthetic can coexist. 

The decision about which technique is best should be made by you and your anesthesiologist in consultation with your neurologist and obstetrician. In competent hands, a general anesthetic for elective cesarean section in a health patient should be safe. There are minor side effects such as sore throat, possible dental injury, and postoperative nausea, as well as rare severe problems that cover a wide range, including aspiration of stomach contents. The most feared complication relates to difficulty with intubation, as pregnant patients are several times more likely to be difficult to intubate (breathing tube insertion) than other patients. One of the most important issues therefore is whether your airway appears normal or "difficult". Please contact your anesthesiologist to learn more about the risks, benefits and alternatives of each anesthetic technique and to make the best plan for your anesthetic care. 

I recently had a spinal epidural during childbirth and am now having severe headaches. The difference is the headache began about a week ago and my child is 5 weeks old. I realize this is an extended period of time. Is there a possible relation? 

ﾠMost post-dural puncture headaches (PDPH) - the official name for a spinal headache - occur with a few hours to days after a recognized dural puncture. A dural puncture is when the needle penetrate the dura - the membrane containing the spinal fluid, nerves and spinal cord. Your headache is unlikely to be due to PDPH because its onset a month later is so distant in time from when the epidural was performed. Another factor is, unless you have forgotten to mention it, that there was no obvious dural puncture - in most case when this occurs, the doctor is aware that the needle has made a hole in the dura. 

There are many cause for severe headache, and quite a few of these can have very serious consequences. Unless these headaches conform to a previous pattern with a known, benign cause, like tension headache or migraine, you should definitely seek immediate medical attention. 

I had a total knee replacement that the doctor wants to repair with an "EPIDURAL". How dangerous is this? I am 70 years old and in good health otherwise. Thank you. 

Briefly, an epidural is a very thin catheter (tube) that is inserted into the epidural space, which is an area just inside the spinal canal. The procedure normally takes less than 20 minutes or so to perform, and usually causes minimal or no discomfort. Anesthetic medication is then injected into the catheter, causing numbing of the legs and abdomen, and allowing surgery to be done in those areas. 

Epidural anesthesia is quite similar to spinal anesthesia. Epidural anesthesia is a standard method of anesthesia for knee replacement surgery. It has at least 4 advantages over general anesthesia. First, because less sedative medication is required, mental recovery tends to be quicker. Secondly, the insertion of a breathing tube, with its attendant risk of sore throat or tooth injury, is not required. Thirdly, nausea and vomiting during the recovery period is less likely. And finally, in many cases the epidural is left in place after surgery to provide excellent treatment of pain. 

All anesthetic techniques have some risk, and epidurals can (extremely rarely) cause such problems as infection, bleeding in the spinal canal, or (more commonly) headache or lowering of blood pressure. The overall risk of serious complications, in most patients, is not different from general anesthesia. 

Does a spinal numb you only from the waist down just like the epidural? 

The effect of a spinal anesthetic is quite similar to the effect of an epidural. The "height" of an epidural or spinal anesthetic (in other words, how much of your body is numbed) depends on how much anesthetic medication is injected through the epidural catheter. Similarly, the height of a spinal depends on how much anesthetic is injected through the spinal needle. 

Your anesthesiologist will decide, based on the operation that is to be performed, how much medication to use. With a cesarean section, the aim is to have the level of numbness around the "nipple line" - that is an imaginary line across the chest at the level of the nipples. 

One of the main differences is that an epidural anesthetic can be made to last a long time by injecting more medication into the epidural catheter. The effect of a spinal anesthetic cannot be lengthened - the medication is injected through the needle, and the needle is then withdrawn. Epidural and spinals are equally safe for cesarean sections and are considered to be safer than general anesthesia for this operation. 

If I had surgery on my knee, can epidural anesthesia used for that, or is it only used for having a baby? I`ll wait for your answer. Thanks 

ﾠI think you already know the answer to your question! Epidural analgesia and anesthesia can be used for surgery on the lower extremities as well as for pelvic operations and for childbirth. It's a common choice for operations on the knee. 

Among the benefits are the avoidance of sore throat or dental injury from breathing tubes, the operation can be done with minimal or no sedation, rates of nausea are much less, and the patient is pain-free in the recovery period until the anesthesia wears off. Not everyone is a candidate for epidural anesthesia however. For outpatient surgery the home-ready recovery time tends to be a bit longer than for general anesthesia. Older men may experience difficulty with urination. A few patients (1% or less) develop headache. For a fuller discussion of risks and benefits that apply to you please check with your anesthesiologist. 

It has been almost 3 weeks since my section and i am still experiencing pain in my neck which eventually leads to a bad headache. The neck pain is very tender to the touch and very annoying. It seems to get worse if I lie down, especially on my back. It almost feels like a sinus headache at the base of my head. During my operation I had shoulder pain. Then later in the day it moved to the side of my neck and now at the base of my head. My doctor thinks it is referred pain from the operation. I just want to know that this will go away, he said it could last 2 weeks but it has been 3. I have been taking advil but stopped about 4 days ago because the pain is still there. What do you think? 

I'm not sure what is causing your pain but I can comment on the known relationships between headache and epdiural and spinal anesthesia. About 1 in every 100 or 200 patients who have an epidural or spinal anesthetic - (I am assuming this is what you had) - end up with a headache. This headache has particular characteristics. It's often a really bad headache, but usually goes away after a week or so, although it can persist for longer. The most important, distinguishing feature of this particular headache is that the headache will go away when you lie down. Because your headache gets worse when you lie down, I really don't think this is what you have. 

Shoulder pain during cesarean section is quite common. It is, as you said, "referred" pain. Another example of referred pain is the discomfort felt in the arm or neck that some people get with heart pain (angina). This means that there isn't anything wrong with your shoulder. Rather, the pain is felt there as a result of physical trauma elsewhere. In the case of a cesarean section, the shoulder pain is probably due to irritation of the peritoneum. The strange phenomenon of referred pain is due to the way the nervous system is "wired". The referred shoulder pain from a cesarean section normally doesn't last more than a few days, and doesn't migrate to the neck or base of the head the way you've described. 

After 3 weeks, the pain from a cesarean section should be very manageable, although not entirely gone. It would be quite unusual to experience the pain you've described. Perhaps something else is going on - sinus headache, fibromyalgia, or some other muscular or skeletal problem. However it sounds as though the Advil wasn't helping you, which makes a muscular/skeletal problem a bit less likely. My recommendation, if the pain is not improving, is to go see your doctor again or seek a second opinion. 

My daughter has been experiencing neck pain and headaches since her epidural/spinal for a c-section. They did a blood patch the following day after her surgery, but four days later, the problem still exists. What can be done to alleviate this pain? How long can she expect to experience this type of pain? Is the neck pain normal? 

An epidural blood patch is the recommended treatment for severe post-dural puncture headache (PDPH). Dural puncture is a recognized complication of spinal and epidural anesthesia that unfortunately occurs in around 1% of cases. The blood patch is effective about 90% of the time. In cases where the patch does not relieve the pain it is sometimes necessary to repeat the procedure on a second occasion. After a second blood patch almost all patients will have their pain relieved. 

A PDPH is a self-limiting condition. In other words, the pain will eventually go away, even without treatment. This may however take more than a week, and during this time the patient with a severe headache is often quite unable to function normally. The hallmark of PDPH is a headache that is postural - it occurs when standing or sitting and so the patient is forced to lie in bed. Not the ideal position for a mother with a new baby! 

Epidural blood patch is a very safe procedure, but, like any medical procedure is not completely without risk. One of those risks is that another hole is made in the dura, leading possibly to a worsening, not improvement, of the condition! The person performing the blood patch ideally is someone with a fair amount of experience doing epidural anesthesia. 

The decision to repeat a blood patch should take into account the risk, and inconvenience of a blood patch, versus the amount of pain being experienced and its effect on the patient. If another blood patch is not done, the treatment would be analgesics (pain medication) such as acetaminophen, anti-inflammatories or codeine, and lots of fluids. High doses of caffeine have also been shown to help. Although the diagnosis of PDPH is usually obvious, it is a "diagnosis of exclusion". That means that other, potentially serious conditions, such as meningitis, must be "ruled out". This requires the doctor to take a careful history and do a physical examination and possibly some blood tests or imaging (xray) studies. 

During the delivery of my son I had a spinal for a unplanned C-section, when the spinal was done a nerve was hit and it was like an electric shock went through my leg to my foot and back up my leg. This was extremely painful. As time went by the tingling sensation subsided a bit to where I was not constantly aware of it. My doctors told me it would take about 6 months to heal. I am now pregnant with my second child, they will be 12 months apart and my leg is giving me problems, I have a constant tingling sensationan and if its touched or rubbed it feel like pins and needles. It also has been swelling up, no other part of my body swelling but this ankle and foot. Is this something to be concerned about, will it heal on its own? 

ﾠNerve injury is a possible explanation for your initial symptoms. This could have resulted from direct contact between a nerve root and the spinal needle. But bear in mind that nerve injury can also occur from pressure of the baby`s head on other nerve structures during labor. 

The swelling and the tingling sensation that occurs when you rub the leg suggest the diagnosis of complex regional pain syndrome, also known as reflex sympathetic dystrophy. This is a chronic pain disorder associated with nerve injury as well as other kinds of trauma. The symptoms can be long-lasting, and require specialized treatment. 

I advise you to see a pain specialist to confirm the diagnosis and advise on treatment. This type of nerve injury occurs very infrequently with spinal anesthesia. For your forthcoming delivery you should discuss the options with your anesthesiologist. Even with your history an epidural or spinal could still be a reasonable option, as regional anesthesia is usually considered to be a better overall for mother and baby. 

I recently had a c-section (about 2 weeks ago on 8/1/07) -- the anesthesiologist gave me the numbing needle for the spinal (im positive it was a spinal) and then, when he put the spinal needle in, he made 3 attempts before he got it into the place he wanted it. I got the sensation of being karate chopped in the back when he got the place he wanted. I laid down on the table and my feet started to go numb.. as did the rest of me up to my chest. 

After the c-section I felt fine, aside from the usual pain of my incision. Just before I went home, 4 days later, I started to get this numbness and tingling in my right hand. It feels like pins and needles. I asked my OB about it just before leaving the hospital, and he told me that he thought it was excess water in my hands, and that it should go away within two weeks. Well it still hasnt gone away, as a matter of fact, it seems to have moved up my arm to my elbow. I do get feeling on occasions, but id say 80% of the time its pins and needles or its numb. is this because maybe he (the anesthesiologist) hit some nerve during one of those times he tried to re-insert the needle?? And if so how long is this feeling going to last? I hope its not going to keep moving up my arm! Should i go see a specialist?? 

ﾠIt's unlikely that your spinal anesthesia has anything to do with the symptoms you are experiencing in your arm and hand. The needle would have been inserted in your lower back, far from any nerves that supply your upper extremity. Your symptoms are more likely due to a nerve problem in your neck, elbow or wrist, unrelated to the anesthesia. I suggest you seek help from your family physician or a neurologist. 

Is there pain during the c-section with anesthesia being used? Why do some women say they feel pain during the actual c-section? 

C-Sections are usually done with spinal or epidural anesthesia, not general anesthesia. This has been shown to be safer for both mother and baby. Unfortunately, neither spinal nor epidural can GUARANTEE a cesarean section that is completely without discomfort. Why is this so? Sometimes is is a matter of time. The baby must be delivered quickly (e.g. fetal distress) and not enough time is available to ensure that the spinal or epidural has "set up" to provide complete lack of sensation. 

Sometimes it is a matter of dose - not enough anesthetic has been given. In the case of epidural anesthesia, medication is added bit by bit, to make sure that the block does not spread too high. With spinal anesthesia, a single dose is given, based on various factors including the particular anesthetic drug given, the type of patient, and the expected duration of the procedure. That standard dose might be insufficient for the occasional person. 

Sometimes, the epidural or spinal, for a variety of reasons. is "patchy" - that is, the person is quite numb in one area, but not throughout the area where the surgeon is operating. When these problems occur, there are are various methods available to treat the pain. Intravenous medication can be given to treat the pain. Local anesthetic can be injected by the surgeon. Finally, a general anesthetic can be given. 

I should add, that even with a successful spinal or epidural anesthetic, the patient can expect to feel some minor discomfort. When the baby is delivered pressure is applied to the abdomen, which can hurt. When the uterus is manipulated as it is sewn up there can also be some discomfort or nausea. 

In addition, spinals and epidurals do not block every kind of sensation. Pressure and touching very often continue to be felt as the surgery proceeds, and some people will find this uncomfortable or even painful. The vast majority of patients are easily able to tolerate these sensations if they are forewarned and have a sympathetic medical team and a birth companion. There is a reward for the effort! 

During my first pregnancy I had an epidural and when the anesthesiologist inserted the needle or tube an excruciating pain went all the way down my leg like a lightening bolt. It went away suddenly but that was the worst pain that I have ever had in my life (worse than the labor itself). I ended up having a C-section and I am fine now. This time, I plan to have a VBAC and I may need an epidural but I am very concerned that this would happen again. I am worried that I am going to be so anxious about getting the epidural that it will make my labor pain worse so I will try to have a natural childbirth. What causes this and is there a high probability that it will happen again? 

ﾠDuring the insertion of an epidural, a tiny plastic catheter (tube) is inserted through a needle and into the epidural space. This is the space just outside the membrane - the dura - that covers the spinal cord and spinal nerves. The catheter is normally inserted a few centimeters beyond the needle tip and the needle is then withdrawn, leaving the catheter in place. Modern techniques of epidural analgesia for labor and childbirth have an excellent safety record. Permanent injury to the spinal cord or nerves is extremely rare. Occasionally however, during insertion of an epidural, the catheter will brush up against a nerve. This is a chance occurrence that can produce a transient sensation (feeling) almost like bumping one`s `funny bone`. Sometimes the sensation is painful and the pain can spread down one leg, as described in the question. 

The severe pain described above is unusual and unlikely to recur during a subsequent epidural. The majority of VBACs (Vaginal Birth After C-Section) do result in vaginal deliveries, but there may be a 40% or higher risk of needing a C-Section. As epidural or spinal anesthesia is the preferred anesthetic for C-Section (safer for both mother and baby), it would be unwise to avoid an epidural because of the fear of the type of problem described in the question. 

I had a spinal with my c-section. I recently found out I have paralysis of my right vocal cords. My doctor had me get a ct scan of my head neck and chest which revealed paralysis of my right diaphragm. I can`t get in to see a lung specialist for another 2 months. I am wondering could the spinal have caused this and what other tests could I have done to regain proper function. Will this be permanent? 

The nerves that supply the vocal cords come from the vagus - the tenth cranial nerve. The phrenic nerve supplies the diaphragm. I think it is most unlikely that the spinal anesthesia would have caused paralysis of your vocal cords and diaphragm. A rare complication of spinal anesthesia is cranial nerve palsy, affecting the third, fourth or sixth cranial nerves, but paralysis of the vagus nerve or phrenic nerve has not, to my knowledge, ever been described. The cranial nerves are nerves that emerge from the lower part of the brain. The third, fourth and sixth cranial nerves pass to the eye muscles, controlling the movement of the eyes. Nerve problems caused by spinal anesthesia usually recover over time. 

What is more likely is that there may be a problem in a single area of the right lung or the mediastinum - the area in the center of the chest - that is affecting both the phrenic and vagus nerves. You should make sure that you follow up with your doctors as soon as possible because of the possibility that a serious disease is responsible for the problems you have described. 

Recently, my aunt had surgery to remove spots on her lungs. She was given an epidural for anesthesia. Things went well until they removed the epidural approx. 24-36 hours after the surgery. After it was removed my aunt became severely paranoid. She thought that the doctors and nurses were "out to get her" and even though it is now a couple weeks after surgery and she is home, she still thinks that the people in the hospital were out `to get her". Is there any literature on this topic that I could read? Is this a common occurence of epidural anesthesia, or at least IS it a side effect? I was told that people who are alcoholics sometimes have adverse affects from an epidural..my aunt isn`t a full time drinker, but she`s a once a week drinker...does this maybe have something to do with it? I also know that the doctors gave her something for pain after removing the epidural, but I`m not sure what it was, and they themselves didn`t think it had anything to do with her paranoia. Any information you can give me about this would be greatly appreciated. 

I don't believe that your aunt's psychiatric symptoms have anything at all to do with the epidural anesthesia or analgesia. In fact, a regional technique like epidural or spinal anesthesia is often the best choice for patients with brain syndromes because it avoids or at least minimizes the amount of sedative and anesthetic drugs needed. These are the drugs which definitely do act on the brain and can sometimes worsen the condition of patients with dementia or delirium. Similarly, there is no connection that I am aware of between alcoholism and any side-effects of epidural anesthesia. There is a tendency to blame the anesthesia for a variety of side-effects or problems after surgery. These suggestions must be treated with caution. The recovery from surgery (a major, controlled injury) may include tissue breakdown and wound healing, inflammation, nutritional stress, pain and pain medications, infectious challenges, fever, immobility, change of environment, and drug or alcohol withdrawal. It is hardly surprising therefore that the mental state of patients during this time is not always normal. 

I gave birth six and a half years ago. The doctor began to give me an injection into my spine and I jumped away from the needle. The doctor pulled the needle back out and then reinserted the needle. I started having problems right after I gave birth. I woke at night every night with my arms completly numb for about a year and a half. It still happens though not as frequent. My left arm after a few weeks began to hurt and over the years the pain is continuous and has intensified. I have pain in my right leg that the doctor says is sciatica. I have pain in my upper and lower back. I get very bad head aches and my memory seems to be deteriorating. I have problems with my right hand as well. Could any or all of this be related and how can I get proper help and immediate releif. 

I doubt very much that the problems you have described have anything to do with your spinal or epidural anesthesia so many years ago. Although neurological problems can occur after spinals or epidurals, these problems usually take the form of either headache, or nerve injury. The headache occurs after about 1 in 200 epidurals, and usually goes away within days. Nerve injury is pretty uncommon and will affect nerves at the level of the needle insertion. That means the lower limbs may be affected. When a nerve injury does occur it fortunately will also usually get better but may take a few months. 

I think you need to seek the help of a neurologist to try to identify what is affecting you so badly. It may be a combination of things. Some of the diagnoses that spring to mind include disc herniation in the lower back and neck, carpal tunnel syndrome andﾠfibromyalgia. Psychological illnesses such as depression might also be involved. Please talk with your doctor. 

I was diagnosed with Pseudocholinesterase Deficiency at age 10 after having a tonsillectomy and not waking from the anesthesia for 3 hours. I am now 28 years old and am pregnant with my first child. I am due in March and have been wondering about what type of pain management I will use during labor. I am very worried about having any type of anesthesia due to my condition. Is there any risk to having an epidural during labor with Pseudocholinesterase deficiency? 

Thanks for your question. Don't worry. Your risks from an epidural are no different to any other normal healthy patient's risk. You should be offered the same pain management options as anybody else. Pseudocholinesterase deficiency is only a problem if you are given the muscle relaxant drug succinylcholine. If you needed a general anesthetic to get your baby out in a hurry this is the drug that the anesthesiologist would use. However there are alternatives, so all you need to do is make sure that your enzyme deficiency is well documented in your doctor's and hospital's records. Also, if you are planning to get an epidural, this makes the likelihood of needing a general anesthetic for a cesarean or any other obstetrical surgery rather small. You should also consider getting and wearing a Medic-Alert bracelet with the information about your pseudocholinesterase deficiency on it. 

My daughter had an epidural/spinal anesthetic for her C-Section 12 days ago. Immediately when positioned on the surgery table she noted right shoulder pain that increased to severe neck and bilateral shoulder pain by the 2nd post op day. This required 2 Percocet every 4 hours to merely dull the pain. This treatment continues today to manage the pain to this same `dull` level. Since her 3rd post op day the right shoulder has been free of pain but her left shoulder, neck and around her shoulder blade (medial edge and under) continue to be extremely painful (a 10 on the 1-10 pain scale) without the 2 Percocet every 4-5 hours. She cannot tolerate even the lightest tough to her shoulder without the analgesics in effect. She also found that Rx Motrin was not effective. 

The pain is now progressing to a radiation of aching down her left arm and hand. She is normally very sensitive to any medication. Before the C-Section, she required only 1 tablet of Tylenol or Advil, occasionally, to manage other types of pain. She has been evaluated by anesthesia, who prescribed the Percocet and Motrin, without a diagnosis; her OB Dr, without a diagnosis, who referred her to an Orthopedic MD who ruled out a rotator cuff problem, who prescribed Physical Therapy also without a diagnosis. She will start Physical Therapy next week. Chiropractic and acupuncture have provided a bit of short term relief but not lasting. The extensive medication is a concern for this breast feeding mother as is her ability to care for her baby while severe pain or in a medicated state. Any insight and suggestions are appreciated. Thank You. 

Your daughter's history is a complicated and puzzling one. It seems very unlikely that her epidural or spinal anesthetic had anything to do with the pain she is now experiencing. I certainly have not encountered or read about anything resembling this in relation to a regional anesthetic. If there were a direct nerve injury from the anesthetic we would expect a history of pain at the time of insertion of the needle, and we would expect symptoms to be limited to the lower part of the body. Headache is a well-known complication of epidural or spinal anesthetic (about 1 in 100-200 cases) but you do not mention headache as part of the problem. Your daughter needs a proper evaluation by an expert clinician - perhaps a neurologist - to establish a diagnosis. The clinician will need to know a lot more than what you've told me, including whether there was any previous history of pain, of muscular or skeletal problems, vascular disorders, neuropathy, trauma, etc. A careful physical examination is also needed. 

My doctor saysﾠI won`t be numb long from the spinal.ﾠI am hoping this is true becauseﾠI am scared of the numbing and afraidﾠI am gonna panic. Is this true about the numbing? 

The duration of a spinal anesthetic depends on which local anesthetic medication is used, and how much of it. At the one extreme, a spinal anesthetic with a small dose of a medicine called chloroprocaine may last for only 45 minutes or so. On the other hand, with a medicine called tetracaine, the anesthetic can last well over 4 hours. 

The duration that is needed obviously depends on the duration of the surgery. It is rather upsetting for all concerned if the surgery is still going on when the spinal is no longer working! Because surgery is not an assembly line process and has a certain degree of unpredictability, we prefer to err on the side of having the spinal anesthetic outlast the surgical procedure! In addition, this has the benefit that after the surgery is ended and you are taken to the recovery area, you are likely to be still quite comfortable. As the spinal gradually wears off, pain from the surgery can be treated with pain killers. 

Although the concept of being numbed, and in fact unable to move, is somewhat alarming, most people do very well with spinal anesthesia and I've never seen anyone get really panicky. That is because we won't administer this type of anesthetic to someone who is adamantly against having one, because we almost always administer sedative medicines along with the spinal anesthetic, and because spinals seem to have a kind of sedating effect of their own. 

You should express your concerns to your anesthesiologist who will discuss the benefits, risks and alternatives to spinal anesthesia and in all likelihood, if the spinal is chosen, will give you enough sedatives before and during the procedure to make you, at least temporarily, blissfully content with life. 

I need a total hip replacement and the surgeon I`ve seen says he uses spinals for surgery. I`ve heard bad things about this and wonder how safe that kind of anesthesia is. 

Thanks for your question. You can rest assured that spinal anesthesia is a safe choice for hip surgery. Many patients when offered this type of anesthesia are concerned about serious side effects, such as paralysis, and also about troubling but less dangerous side effects, such as headache. There seems to be a common, although false, perception that these complications occur often. In fact, spinal anesthesia has a long track record of safety, with a rate of serious complications (low!) about equal to the rate of major problems with general anesthesia (also low!). 

Studies that have looked at the overall outcome of spinal and general anesthesia for hip surgery have not found a completely convincing advantage of one over the other, and therefore both types of anesthesia are commonly used. In our hospital, at least half of the hip replacement surgery is done with spinal anesthesia. Among the reasons it is favored, include: (1) more rapid recovery of mental function, (2) the lack of need for insertion of breathing tubes, (3) the lower incidence of nausea or vomiting, and (4) the prolongation of anesthesia after completion of surgery, which means a longer pain free period. 

Paralysis after spinal anesthesia is very rare. The number of patients who develop a headache is also quite low in expert hands and using appropriately sized (small) needles, fewer than 1% or so of patients should have a headache. Although a "spinal headache" is troublesome, it is not life-threatening. 

Not all patients are candidates for spinal anesthesia. We do not offer this technique to patients who are at risk for internal bleeding problems or to patients with infection in the area where the needle is inserted. In our hospital, we try to offer a realistic explanation of the different anesthetic techniques, their risks and benefits. Assuming there is not an absolutely compelling reason to choose a particular technique, we usually allow the patient to make a choice. It is best for you to have this discussion with your anesthesiologist, the physician who will be responsible for this aspect of your care.ﾠ 

I had a Spinal 7 weeks ago for a scheduled c-section (this was my second cesearean). I am still experiencing numbness and tingling sensations around my tailbone area, especially when i am sitting down. Is this normal? and what should I do about this? 

Assuming that you had no such numbness before or during your pregnancy, I would say this is not at all normal. What you should do, definitely, is check in with your OB-GYN and/or with the anesthesiologist who took care of you, for further evaluation. 

Neurologic symptoms, (that is numbness, tingling, loss of sensation, pain, or weakness) that occur after natural childbirth can be related to epidural or spinal anesthesia. However these symptoms are more likely to be due to the compressive effects of the baby's passage down the birth canal. In your case, with an elective cesarean section, there was presumably no labor so this is probably not the explanation! 

It is possible that a sacral spinal nerve root, which supplies the tailbone area, was injured during the spinal anesthetic. Was there a sharp sensation in the tailbone area during the insertion of the needle? Was there a sudden, tingly, or "funny-bone" feeling? Such injuries (a neuropraxia) normally recover without special treatment over a few months. If a spinal catheter was inserted and used to maintain the anesthetic it is possible that this would have traumatized the nerve roots. However spinal catheters are rarely used today in the United States. 

Another possibility is that the spinal anesthetic medication could have irritated the nerves. One of the most commonly used anesthetics, lidocaine, has fairly recently been recognized to sometimes cause irritation (labeled Transient Neurologic Syndrome); this is experienced as a painful sensation in the buttocks and thighs after the anesthetic which invariably gets better within a few days. 

A final possibility is that a little bit of bleeding was caused by the insertion of the needle, and the blood has irritated the nerve roots. This would be expected to improve over a few days also. 

Are you certain that a spinal anesthetic, and not an epidural, is what you received? An epidural anesthetic has many of the same potential complications. The presence of the epidural catheter may be associated with a slightly higher rate of minor nerve injury than a spinal anesthetic. 

Although I am trying to cover the range of potential anesthetic complications that might be causing your symptoms, please keep in mind that all of these are rare. It would be very important to look for other causes which have nothing at all to do with your recent anesthetic. The anesthetic might just be coincidental. Do you have any pre-existing back complaints? Slipped discs can occur at any time. The softening of ligaments that occurs during pregnancy might predispose to such problems. Do you have any numbness or tingling elsewhere? Any recent trauma? Any problems with bladder or bowel incontinence? Without wishing to be alarmist, it is possible for very very rare disorders such as spinal tumors to present with such symptoms, the so-called cauda equina syndrome. In short, most neurologic injuries related to spinal or epidural anesthesia are mild and resolve on their own within weeks to months. But without a full evaluation one cannot say what is causing your symptoms. The correct course of action is to consult your doctors, who can take a careful medical history, and do a thorough neurologic examination to try to arrive at a likely diagnosis. 

I had a spinal block done when I had a c-section. I have been having dizzy spells off and on since then. Could this be a side effect of the spinal block? I didn`t have them beforehand. 

Spinal block has a number of potential side-effects but almost all are quite short-lived. The neurological (brain and nerve) side-effects include headache (1 or 2%), which can last several days, and certain cranial nerve problems (very rare) which can cause double-vision, and even hearing loss. If dizziness is your only symptom I think it is very unlikely to be caused by a spinal block more than 2 months ago. Dizziness is a very common symptom dealt with by family physicians and internists, with many possible causes. If the dizzy spells are not going away you should seek help from your doctor. 

6mths ago I had a C-Section in which they administered a spinal. Since then, the part of my spine where the needle went into has been very tender, it is painful to touch, and extremely painful when I am in certain positions (e.g. I am no longer able to be in certain yoga positions I could previously do without a problem). Is this a normal side effect of a spinal? If so, how long will it last? If not, is this something I should see a general practitioner, chiropractor, etc. about? What is the pain from? 

A small amount of tenderness at the site that the spinal needle was inserted is fairly normal. This might last a few days or so. Also, about 50% of women have back pain after labor and delivery. This occurs with or without an epidural or spinal. 

Your pain is unusual and I am not sure how to explain it. Is it getting worse or better? Is it right in the center of your back? Is the area of tenderness warm or red? The first thing would be to rule out a serious problem such as an abscess (infection). You would be probably be feeling unwell, the tenderness would be worsening and there might be signs of inflammation (warmth and redness). 

If the pain is related to movement there might be a problem with a spinal ligament or a small joint in the spine. There may have been a bit of bleeding caused by the passage of the needle and now a hematoma (blood clot) that is taking a long time to get absorbed. Or perhaps there were repeated attempts to insert the spinal needle and hence more than the usual amount of damage to the muscle through which the needle was inserted. 

You should see your general practitioner. Let her assess the problem with the benefit of a full history, and a physical examination. If the problem is musculoskeletal your GP can help you decide whether to see a chiropractor. 

Iﾠhad a spinal anesthesia for surgery to have a McDonald stitch done.ﾠﾠI am 14 weeks pregnant and it`s been 2 weeks since the surgery, butﾠI am still getting these headaches. MyﾠOBﾠdoctor prescribed my some headache medicine but my headaches last untilﾠI go to sleep, sometimes 48 hours.ﾠ How long willﾠI be getting these headaches? 

ﾠThere are many possible cause of headache. You need to find out whether your headache is related to the spinal anesthetic or not. A "spinal headache" is usually postural - that is, it worsens considerably when you stand up, and is minimal or absent when you lie down. If your headache is postural you should try to be evaluated by your anesthesiologist. If a spinal headache is diagnosed, there are specific treatments that can help, such as an epidural blood patch. If a spinal headache is untreated it will eventually go away but this may take several days or weeks. 

Iﾠam 29 years old and 35 weeks pregnant.ﾠI often have neck pain and dizziness due to wrong neck postures. These subside on rest on flat bed without pillow. My neck is short. OtherwiseﾠI am perfectly healthy. IfﾠI plan a caesarian, what would be better a spinal or general anaesthesia? 

Unless you have problems in the lower part of the spine I do not think your neck pain or dizziness will affect the decision about which type of anesthetic you should have for a cesarian section. However you should consult with your doctor to identify the cause of your symptoms. The evidence is rather compelling that regional anesthesia (that is spinal or epidural anesthesia) is the best option for routine, elective cesarian section. Among a variety of benefits for this approach, regional anesthesia: 1) Eliminates the transfer of anesthetic medication to the baby. 2) Avoids the potential for difficulty with airway insertion during a general anesthetic. 3) Allows the mother to be awake during the delivery in order to begin bonding with the baby as well as simply to enjoy the birth experience 

My wife is having a scheduled c-section (VBAC), and her doctor said she will need to undergo a spinal for her anesthetic. With our first, the c-section was done in an emergency, and she had an epidural. She had no headaches or side effects from the epidural. We have heard bad things about the spinal,often causing severe headaches, even migraines long after the birth. From what I`ve found, the spinal is preferred because it makes the procedure simpler for the docs and nurses. Can you tell me any reason why it would benefit her more, in terms of recovery, to go ahead with a spinal instead of an epidural? 

A spinal anesthetic involves the insertion of a needle, usually in the lumbar (low back) region, followed by the injection of a local anesthetic solution. The needle is then withdrawn, and the anesthetic effect occurs quite rapidly. Spinal anesthesia has been around for a long time, and is recognized as a safe and effective means of providing anesthesia for cesarean section. Because the onset of anesthesia is very rapid and reliable, some centers use spinal anesthesia routinely for elective c-sections. 

The alternative method, epidural anesthesia, tends to be a bit slower in onset, and may result in a slightly less "dense" block (that is, sensation is at the surgical site is not eliminated as completely as with a spinal anesthetic). 

Unfortunately, headache can occur after a spinal anesthetic and this may be a significant, though not a life-threatening problem. The headache, sometimes called a "spinal headache" is thought to be due to leakage of spinal fluid through the tiny rent in the membrane that is made by the spinal needle. The resulting drop in pressure of spinal fluid probably causes traction on the spinal membranes, resulting in pain. The pain usually occurs when the patient stands up, and disappears when lying down. 

A spinal headache can be treated with pain-killers and oral fluids. If these simple measure are not successful, an injection of the patient's own blood into the epidural space, in the same region as where the original spinal block was done, is amazingly effective at eliminating the headache. This technique is known as a blood patch. 

During the performance of an epidural anesthetic, the needle tip is placed in the epidural space, which lies just outside the membrane covering the spinal fluid. Occasionally, even in experienced hands, (perhaps 1 in 200 times), the needle can cause a small tear in the membrane itself. When this happens, a spinal headache can also occur. 

In our center, epidurals are used routinely, and very successfully, for the treatment of labor pain and also for c-sections. One benefit of epidural anesthesia for c-section is that the epidural can be left in place after surgery to treat the pain very effectively. A long-lasting pain medication (morphine) can be injected along with a spinal anesthetic, but the duration of pain relief is only about 12 - 24 hours. 

So, both spinal and epidural anesthesia can cause headache. And the incidence of spinal headache is about the same for both techniques. In the case of spinal anesthesia, the use of the tiniest needle possible, and the use of particular types of needle with rounded tips, is thought to reduce the incidence of headache. I would strongly suggest that in order to allay your fears you ask to discuss the anesthetic technique, its risks and benefits, with your anesthesiologist well ahead of the surgery.