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Spinal anesthetic is used to numb a patient for surgery from the waist down, so that the patient can remain conscious. There is less risk than with general anesthesia. It is for the most part used for lower abdominal and lower extremity surgeries. Doing a spinal above the lumbar area has more risk to the spinal cord.

Spinal anesthesia differs from epidural anesthesia. In both a spinal and an epidural, a long needle is inserted between the spinous processes in the back. In a spinal, numbing medicine is injected and the needle is removed. For an epidural, a very thin catheter is threaded through the needle and the needle is removed. Medicine can be given through the epidural catheter, so an epidural lasts longer.

Most epidurals and spinals are done below the tip of the spinal cord. The spinal cord ends at the L1/L2 lumbar vertebrae, though the nerves continue down through the spinal canal until each exits at its particular vertebra. The dura is the tissue sack around the spinal cord, so epidural means outside the dura.

Most of my experience with spinals and epidurals is in obstetrics. A spinal is used for a scheduled caesarean section. The spinal will wear off, but we can do the delivery and repairs before it wears off. If a woman is in labor, a spinal or an epidural may be used, depending on the situation. In many deliveries, no anesthesia is needed, but not in all. One situation is that labor has arrested: labor has gotten to a certain point and then just seems to stop. Infection interferes with contractions, so labor stopping is not reassuring. In that case, I would recommend an epidural, because it is not clear how long labor will be or if we will need to do a caesarean section. With an epidural, dose can be increased or decreased, but to re-dose the spinal, a new needle must be inserted. If we are at the point where a caesarean section is needed and the mother and fetus are doing fine, a spinal will wear off more quickly. In an emergent caesarean section, general anesthesia is the quickest.

for THE DREAD CHAMBER and of course, the ages

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