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Evidence Library · Anesthesia

Side effects of a spinal during the operation

Low blood pressure, nausea, shivering and itching are all common.

Low blood pressure after a spinal is so common that prevention is standard practice. A review of 125 trials and 9,469 women examined the techniques used to prevent it, which include intravenous fluids, medications such as phenylephrine or ephedrine, and leg compression.

How often it happens depends almost entirely on how you define it. A review of 63 publications covering 7,120 patients found 15 different definitions in use, and applying them to the same group of women produced rates ranging from 7.4% to 74.1%. Any single percentage you are quoted for this is a choice of definition as much as a fact.

Long-acting morphine placed in the spinal gives excellent pain relief for about 24 hours, but it causes itching. In a meta-analysis, itching was 1.8 times more common at lower doses and 5.0 times more common at higher doses compared with placebo, and vomiting was 3.1 times more common at lower doses.

Shivering is very common and is not dangerous. Nausea often improves once blood pressure is corrected.

Where this comes from:
35. Chooi C, Cox JJ, Lumb RS, Middleton P, Chemali M, Emmett RS, et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2020;(7):CD002251.
36. Gehling M, Tryba M. Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia. 2009;64(6):643-651.
37. Klöhr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients. Acta Anaesthesiol Scand. 2010;54(8):909-921.

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