Intrathecal Analgesia

What is intrathecal analgesia?

Intrathecal (in-trah-THEE-kal) analgesia is a type of pain control. Intrathecal analgesia may also be called IA or spinal analgesia. During IA, special pain medicine is put into the area around your spinal cord. IA is used for lower body pain caused by things such as surgery or labor and delivery (having a baby). IA can also be used to control long-term pain from illnesses such as cancer. IA medicine can be given as one single shot, a continuous (steady) infusion, or as small doses when you need them.

What happens when I am given intrathecal analgesia?

• Informed consent: You may be asked to sign a consent form that gives caregivers permission to give you intrathecal analgesia. A consent form is a legal piece of paper that tells exactly what will be done to you. If you are unable to give your consent, someone who has permission can sign this form for you. You have the right to understand your treatment in words that you know. Your doctor should tell you about the risks and benefits of intrathecal analgesia. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Placing the needle or catheter: IA may be given through a needle placed into your back as a single injection (shot). IA may also be given through a long, thin, flexible tube called a catheter. This catheter stays in place so that you can be given pain medicine more than once or continuously for an extended period of time.
  
  
  • You will need to lie on your side with your knees curled up against your chest. Try to get your knees as close to your chin as possible. Your caregiver may want you to sit on the side of a bed or table and bend way forward instead. These positions help to round your back, making it easier to place the needle or catheter between two backbones.
    
    
  • Your lower back will be washed with soap to clean germs from your skin. Tell your caregiver if you are allergic to iodine or any medical cleansing solution. You may be given one or more shots of numbing medicine under the skin of your back. Tell your caregiver if you are allergic to pain medicine, lidocaine, or any dental or numbing medicine.
    
    
  • Hold very still and keep your back as rounded as possible during the placement procedure. You may feel some pushing or discomfort as the needle enters your back. Tell your caregiver if you have pain that does not stop within a few seconds. Your caregiver may need to insert the needle more than once. A small bandage is put on your back after the needle is taken out. If a catheter is staying in place, a dressing will be put over it.
    
    
  • Tell a caregiver if you have any of the following symptoms during or right after the placement procedure:
    
    
    • Headache or back pain.
      
      
    • Nausea (upset stomach).
      
      
    • New or worsening tingling or numbness (loss of feeling) below your waist.
      
      
    • New problems with moving your legs or feet.
      
      
    • Trouble breathing.
  
  
• Monitoring: Caregivers will watch you closely for any problems while you are receiving pain medicine. Caregivers will check the injection or catheter site to make sure it is not bleeding too much, leaking fluid, or swelling. You may be asked to wiggle your toes. Tell a caregiver right away if your pain is not being controlled. Your care may also include the following.
  
  
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

What if I get a spinal headache?

Although uncommon, there is a small chance of having a spinal headache after receiving intrathecal analgesia. This is most likely during the first few hours to several days after your intrathecal analgesia is first given. The discomfort of a spinal headache can range from mild to severe (very bad). The headache may get worse when you sit or stand. You may have neck pain or back pain as well. Things that may decrease the pain of a spinal headache include the following.

• Lie down as much as possible until your headache is better. Tell your caregiver if your headache is very bad and it does not get better after you lie down for a while. Caregivers may give you a medicine such as acetaminophen or ibuprofen to decrease your headache pain.
  
  
• Increasing your intake of caffeine may decrease the pain of a spinal headache. Examples of liquids that contain caffeine may include coffee, soda, tea, and sports foods and drinks. Do not increase your caffeine intake unless your caregiver tells you to.
  
  
• You may be asked to drink more liquids for the first 12 to 24 hours following your procedure. This may help decrease your chance of having a spinal headache. For most people, good liquids to drink include water, milk, and juices. Tell your caregiver if you cannot drink more liquids because of another medical condition (such as heart failure).

Risks:

There are risks with intrathecal analgesia. You could have a bad reaction to the medicine. Your blood pressure may drop too low. The medicine may make you breathe too slowly or could make you feel very sleepy. You may have nausea (upset stomach) or vomiting (throwing up). The medicine could make your skin very itchy. You might have trouble urinating. You could have bleeding, swelling, or a leakage of spinal fluid around the catheter or shot area. Rarely, you could have an infection of your head or spine. Caregivers will watch you closely and treat any problems. Call your caregiver if you are worried or have questions about your care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.