Saddle block - a special form of spinal anesthesia

definition

The saddle block is a special form of anesthetic that is relatively limited to the external genitalia, the anus, the pelvic floor and the perineum. This anesthetic is therefore particularly popular in gynecology, urology and proctology.

What is a saddle block?

The saddle block is a special form of spinal anesthesia. The sacral segments of the spinal canal are particularly affected.

A distinction is made between the real saddle block, also called breeches anesthesia, and the extended saddle block, which also reaches the lumbar segments. The real saddle block is used in proctology, gynecology and obstetrics, as well as urology, as it numbs the anus, perineal area, pelvic floor muscles and the external genitalia.

Operations on abdominal organs are only permitted with the extended saddle block. It is a relatively safe procedure with side effects similar to normal spinal anesthesia, but these side effects are mostly mitigated.

This topic could also be of interest to you: What is spinal anesthesia?

Indications for a saddle block

Since with the real saddle block only the external genitalia, the anus, the pelvic floor and the perineum are anesthetized, the indications are relatively limited. The saddle block can be used in obstetrics, for surgical interventions on the anus, for example removing hemorrhoids, and also for removing tumors from the skin and mucous membranes.

With the enlarged saddle block, operations can also be performed on the lower abdominal organs, such as the uterus.

In general, with anesthesia, the least intrusive method should always be chosen. For this reason, the saddle block is very suitable for the procedures described above, as a larger stunning field is not necessary.

Since the saddle block is often used in obstetrics and represents a form of spinal anesthesia, we recommend our website for further information: Spinal anesthesia during a caesarean section

Implementation of the saddle block

In all anesthesiological procedures, educating the patient is paramount. The patient should also have the opportunity to ask questions. The actual implementation takes place with the seated patient. In rare cases, a side position can also be used.

The intervertebral space between lumbar vertebrae three and four or four and five is selected for the puncture. The area is thoroughly disinfected as no germs are allowed to enter the spinal canal. First the skin and then the ligaments of the spine are pierced. Finally, the hard skin of the spinal cord is pierced. The drainage of spinal fluid serves to control the position.

The local anesthetic is injected with even and gentle pressure. Since the drug is slightly heavier than the spinal fluid, it automatically sinks to the bottom when the patient is seated. For this reason, the sitting position should also be maintained after the injection until the effect has set in.

Lying down after half a minute leads to the enlarged saddle block. After about a quarter of an hour, the effect should be fully felt.

What anesthetics are used?

The same drugs are used for the saddle block that are used in spinal anesthesia and regional anesthesia. Some examples of local anesthetics used are lidocaine, bupivacaine, and ropivacaine. All of these drugs work in a similar way to their historical ancestry, cocaine. The various local anesthetics differ in their duration, strength and onset of action. In some cases, mixtures of different preparations are used so that the respective advantages can be used.

If you would like more information on this topic, we recommend our website: Anesthetics

Dosing of anesthetics

The dosage depends on many individual factors. Body size and weight play a role here, since the distribution space for the drug increases with body size. The exact drug used also determines the dosage. It is therefore not possible to give an exact dosage. Since some factors cannot be planned in advance, a second dose may be necessary if the first dose is insufficient.

Duration of effect of the saddle block

The duration of the saddle block depends on several factors. These include the drug chosen, the dose and also some individual factors, such as the rate at which the local anesthetics break down. During longer interventions, a catheter can also remain in the spinal canal so that new doses of local anesthetic can be administered again and again if necessary. Depending on the drug, the effects usually wear off after about two hours.

Advantages of a saddle block

The real saddle block leads to a locally very limited anesthetic and only affects a few regions which are to be anesthetized. This advantage can be used optimally in obstetrics. The sensitive areas of the pelvic floor muscles and the perineum are numbed, while the uterine muscles are not restricted. For this reason, a natural birth can be relatively painless. An advantage of all regional anesthetic procedures compared to general anesthesia is the low effect on the entire body and thus a lower risk of complications.

Side effects of a saddle block

In contrast to risks, side effects are calculated possible effects of the drug or the procedure, which occur relatively frequently. The draining of spinal fluid can lead to tension headaches after the procedure, which should subside after a few days.

A hematoma (bruise) at the puncture site can also occur and in some cases lead to short-term neurological consequences. The local anesthetic can also cause reddening of the skin and local allergic reactions at the injection site.

Further information on this topic can be found at: Long-term effects of spinal anesthesia

Risks of a saddle block

The risks of saddle block anesthesia are very similar to those of classic spinal anesthesia. Injury to nerves can cause permanent damage and abnormal sensations.

Another risk is the injection of a local anesthetic into a blood vessel, as it has severe effects on the cardiovascular and central nervous systems. An allergic shock is also a possible risk when using local anesthetics.

Furthermore, germs can get into the spinal canal and lead to meningitis or abscesses (accumulations of pus). Overall, the risks are to be classified as weaker than with general anesthesia.

You can read more about this topic in the following article: Complications from spinal anesthesia