Spinal anaesthesia is one of the most popular and widely used anaesthetic procedures. It is a simple, cost effective and efficient technique that provides complete sensory and motor block, as well as postoperative analgaesia with a high success rate. Several advantages of spinal anaesthesia include a decreased incidence of deep vein thrombosis, reduced intraoperative blood loss, as well as the prevention of pulmonary aspiration in case of emergency, especially in patients with potential airway problems and known respiratory diseases.

Complications

• Hypotension: Hypotension is an inevitable complication of spinal anaesthesia that occurs when the sympathetic chain becomes blocked, especially when higher dermatome levels are needed. A drop in blood pressure may initiate nausea and vomiting, indicating ischaemia on the spinal cord, which in turn induces an undesired condition for the patient and operating staff.
• Hypothermia: A decrease in body temperature is commonly encountered after neuraxial anaesthesia. Subarachnoid local anaesthetic administration blocks all afferents of skin temperature that patients are unable to release the decrease in core temperature. Vasodilation due to sympathetic blockade increases skin blood flow, which allows for lowering the body's core temperature in a reliable manner.
• Post-dural-puncture headache: PDPH is a troublesome complication, mostly observed in middle-aged women and the obstetric population. Headache rarely occurs in the paediatric population, especially in neonates, but some physicians believe that this may be due to the inability to communicate pain in early childhood.
• Transient neurologic symptoms: Radicular symptoms, including pain, a burning sensation on the buttocks, dysaesthesia and paraesthesia may be observed following spinal anaesthesia. These symptoms generally subside within two days. But these clinical features are alarming for possible serious consequences. There is no representation of these symptoms on radiographs, CT or MRI.
• Urinary retention: Bladder distension during the postoperative period produces discomfort to patients and unless relieved, leads to more severe complications, including permanent injury to the detrusor muscle.
• Haematologic complications: Spinal haematoma following spinal anaesthesia is a severe complication that requires early surgical intervention to prevent permanent neurological damage. The presence of haematoma is frequently suspected in the case of an unexpected increase in the duration of motor block or delay on recovery.
• Infectious complications: Although bacterial meningitis following neuraxial anaesthesia is an uncommon complication, in cases where it does occur it may result in severe harm, including permanent neurologic disability and death.
• Neurologic complications: re-existing spinal pathology or disease increases the incidence of postoperative neurologic complications following neuraxial blockade. Repeated attempts or improper positioning of patients may facilitate neurologic injury.
• Neurological diseases: Patients with pre-existing neurological diseases such as multiple sclerosis, amyotrophic lateral sclerosis, or a post-poliomyelitis condition have previously been considered as relative contraindications for neuraxial anaesthesia.
• Cardiac arrest and perioperative death: Bradycardia and cardiac arrest are the most worrisome complications related to spinal anaesthesia. The incidence of these conditions has been observed to be higher with spinal block in comparison with general anaesthesia.
• Miscellaneous complications: Myoclonus occurs rarely as a complication of spinal anaesthesia in the postoperative period. It may commonly be observed in the presence of systemic illness, drug use or with a pre-existing vitamin B deficiency.

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