Digital Library - Spinal Anesthesia

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Technique of Spinal Anesthesia

Disposable commercially prepared trays are available with different local anesthetic and different size spinal needles.

  1. Patient is positioned appropriately (sitting or lateral).
  2. Landmarks identified and site selected.
  3. Open the spinal tray aseptically.
  4. Gloves put on aseptically.
  5. Prepare the appropriate local anesthetic solution and correct dose according to the type of surgery.
  6. The skin is prepped with betadine solution and draped.
  7. Local infiltration with 1% lidocaine for skin and subcutaneous tissue.
  8. The appropriate size spinal needle is advanced through skin, subcutaneous tissues, supraspinous, interspinous, ligamentum flavum where firm resistance is felt after which loss of resistance is felt when needle enters the epidural space. This is followed by the characteristic "pop" as the needle passes through the dura to enter the subarachnoid space. Once the CSF appears at the hub of the needle the syringe filled with appropriate dose of local anesthetic solution is injected slowly in the subarachnoid space after confirming free flow, clear fluid and no paresthesia. Then the patient is placed in supine position.
Disappearance of Neural Function occurs in the following order
  1. Autonomic
  2. Temperature
  3. Superficial pain
  4. Vibration and position sense
  5. Motor
  6. Touch
Spread of Local Anesthetic Depends Upon
  1. Dose and concentration of local anesthetic drug
  2. Baricity of the solution (i.e. specific gravity of solution compared with CSF)
  3. Patients position during and immediately after anesthetic is given (except isobaric)
  4. Speed of injection, level of injection
  5. Intrabdominal pressure and patient physical condition

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