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Spinal and epidural anaesthesia: how they differ | CION Cancer Clinics
A spinal and an epidural both numb the lower body through an injection in the back. A spinal is one injection that works within minutes and wears off on its own. An epidural leaves a thin tube so medicine can be topped up for days. This page compares them, explains when each is used in cancer surgery, and names who they may not suit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is the difference between a spinal and an epidural?
- How do a spinal and an epidural compare?
- How is a spinal or epidural put in?
- When is each one used for cancer operations?
- Who may a spinal or epidural not suit?
- What do families fear about an injection in the back?
- Common questions about spinals and epidurals
The short answer
What is the difference between a spinal and an epidural?
Both are injections in the back that numb the lower part of the body. A spinal is a single injection into the fluid around the nerves, works within minutes and wears off after a set time. An epidural leaves a thin soft tube in the back, so medicine can be topped up for days.
Why the difference matters for cancer surgery
A spinal is often the main anaesthetic for an operation on the lower body. You stay awake or lightly drowsy while the surgeon works. An epidural is more often added to general anaesthesia for a large operation on the tummy or chest. It is then kept running afterwards to control pain while you recover.
Sometimes you have both
A combined spinal-epidural gives the fast numbness of a spinal with a tube for later top-ups. It is used when an operation may run long, or when strong pain relief is needed afterwards. You may also be offered sedation with either, so you feel relaxed and drowsy while you lie on the table.
Which one suits you depends on your operation and your health. This page cannot make that choice. Your anaesthetist will.Side by side
How do a spinal and an epidural compare?
Spinal
Epidural
One injection, with nothing left in your back
A thin tube stays in your back, taped in place
Numbness starts within minutes
Takes longer to work fully
Wears off on its own after a set time
Can be topped up for as long as it is needed
Often the main anaesthetic for lower-body operations
Often added to general anaesthesia for pain relief
Placed low in the back
Can be placed higher, including for chest operations
In the theatre
How is a spinal or epidural put in?
Getting into position
You sit on the edge of the bed leaning forward, or lie on your side with your back curled. A nurse stays in front of you and helps you keep still.
Cleaning and numbing
Your back is cleaned with a cold liquid. A small injection numbs the skin first. It stings briefly, like a blood test.
The needle
You feel pressure rather than pain. A quick tingle down one leg can happen. Say so out loud, but try not to move.
Checking the numbness
Your legs feel warm, heavy and then numb. The team tests the numb area with something cold before the operation starts.
Afterwards
Nurses check your blood pressure, leg movement and the numb area regularly. With an epidural, the tube is taped up your back and connected to a small pump until it is no longer needed.
Not sure whether this applies to you?
Ask an oncologistIn cancer surgery
When is each one used for cancer operations?
These are common patterns, not rules. Your own plan may differ for good reasons.
A spinal on its own
For operations below the belly button where you can safely stay awake. Sedation can make you drowsy through it.
Often used for
- Bladder surgery through the urine passage
- Some prostate operations
- Some operations on the legs
An epidural with general anaesthesia
You are fully asleep for the operation. The epidural controls pain for the first days, which helps you breathe deeply, cough and move.
Often used for
- Large open operations on the bowel, stomach or liver
- Some chest operations
Neither
Many keyhole operations use smaller cuts and cause less pain. Nerve blocks and pain medicines may be enough, without a tube in the back.
Being straight with you
Who may a spinal or epidural not suit?
For some people, putting a needle near the spinal nerves carries more risk than benefit. Your anaesthetist checks for these before offering one.
Bleeding and blood thinners
If your blood does not clot well, bleeding near the nerves can press on them. Blood thinners, a low platelet count after chemotherapy, and some liver problems all matter here. Never stop a blood thinner on your own. Your doctors will tell you whether and when to pause it.
Other reasons
An infection in the skin of the back or in the blood, some serious heart valve problems, and past major spine surgery can each make it unsafe or difficult. So can a patient who does not want one. That is your right.
What you may notice afterwards
Itching, shivering and feeling faint from a drop in blood pressure are fairly common and are easily treated. You may not be able to pass urine until the numbness wears off. Tell the nurse about any of these, rather than putting up with them.
What this page cannot tell you
It cannot tell you whether you are suitable. That needs your blood test results, your medicine list and an examination by the anaesthetist.
Commonly believed
What do families fear about an injection in the back?
"A spinal can leave you paralysed."
Lasting nerve damage is very rare. Numb, heavy legs for some hours after a spinal are expected, and the feeling returns as the medicine wears off.
"The injection causes back pain for life."
The spot can be tender or bruised for a few days. Long-term back pain is not a usual result of a spinal or epidural.
"With an epidural I will be stuck in bed."
Epidurals for pain relief use a low dose. Many people can sit out and walk with help. A nurse checks your leg strength first.
"Being awake means watching the operation."
A screen blocks your view. You feel no pain in the numb area, though you may feel pushing. Sedation is often offered if you prefer to doze.
!
Signs that cannot wait
After a spinal or epidural, including after the tube is removed and after you go home, some signs need same-day care. Severe or worsening back pain, new numbness or weakness in the legs after the feeling had come back, loss of control of the bladder or bowels, or a fever with tenderness where the needle went in. Tell the nurse at once. If you are at home, go to the nearest emergency department the same day and say you had a spinal or epidural. Do not wait to see if it settles.
Questions we are asked
Common questions about spinals and epidurals
Which is better, a spinal or an epidural?
Neither is better overall. They do different jobs. A spinal is quick and simple for an operation of set length on the lower body. An epidural can keep working for days, which suits pain relief after a large operation. Your anaesthetist chooses based on the operation and your health.
Will I be awake during an operation under a spinal?
You can be, and many people are, chatting or listening to the team. A screen blocks your view. If you would rather not be aware, you can ask for sedation, which makes you drowsy and relaxed. Tell the anaesthetist your preference before you go into the theatre.
Does the injection in the back hurt?
The skin is numbed first, and that small injection stings briefly. After that most people feel pressure rather than pain. A sudden tingle down a leg can happen as the needle passes near a nerve. Say so, keep still, and the anaesthetist will adjust.
How long will my legs stay numb?
After a spinal, the numbness usually lasts some hours and wears off gradually, starting with tingling. With an epidural it lasts as long as the medicine runs, and the dose can be lowered so your legs work better. Tell the nurse if feeling does not return when expected.
Why do I need a urine tube afterwards?
A spinal or epidural also numbs the nerves to the bladder, so you may not feel when it is full or be able to pass urine. A thin tube called a catheter drains the bladder until the numbness wears off or the epidural is stopped. It is then removed.
What is the headache some people get after a spinal?
Rarely, fluid leaks from the small hole the needle made. This causes a headache that is worse sitting up and eases lying flat. Tell the team the same day. Rest, fluids and pain medicines often help, and a simple procedure can seal the leak if it does not settle.
Can I have one if I take blood thinners?
Possibly, but only if the medicine is paused safely first, and some people cannot pause it. The timing depends on the medicine and why you take it. Never stop it on your own. Bring every medicine to your check so your doctors can plan together.
Can I refuse and be put fully to sleep instead?
Yes, you can refuse, and your decision will be respected. Ask the anaesthetist to explain what general anaesthesia would mean for you instead. For some operations it is an equal choice. For others it carries more risk for your heart or lungs, and it helps to know that.
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Sources
- NHS — Epidural
- Royal College of Anaesthetists — Information for patients and carers
- American Cancer Society — Cancer surgery
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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