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Thursday, July 31, 2014
Spinal tap for hernia surgery. What is it?
My husband is having hernia surgery. The hernia has invaded his scrotum. The surgeon has suggested a spinal tap rather than the usual anesthesia due to the patient having a problematic cervical herniation and the neurosurgeon has cautioned him with any intubation procedures that can aggravate the cervical problem. The hernia surgeon has suggested using the spinal tap. Do you recommend this procedure?
"Spinal tap" is the procedure for removing spinal fluid for diagnosis (also the name of a movie about a rock group). What you and your surgeon really mean is spinal anesthesia, also known as a "spinal block". Spinal anesthesia is a useful anesthetic technique for surgical procedures on the abdomen, pelvis and the lower limbs.
While I cannot recommend any particular anesthetic for your husband - that is a decision for you, your surgeon and your anesthesiologist - I can tell you that a spinal anesthetic can be a reasonable choice for hernia surgery, and does avoid the manipulation of the neck that is involved with an intubation procedure (the insertion of an airway tube).
An alternative technique would be the use of local anesthetic infiltration of the hernia site, with or without blocking the specific nerves in that area. This would normally be supplemented with intravenous sedation provided by the anesthesiologist. This approach depends largely on the skill and experience of the surgeon with doing good local anesthesia as he works. Patience is required. If the hernia is very large or complicated this technique may not be feasible.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University