Level of Block

Spinal Anaesthesia also called Subarachnoid block or Intrathecal Block.

Operations

Indications:

1. Abdominal & vaginal hysterectomies
2. Laparoscopy Assisted Vaginal Hysterectomies (LAVH) combined with general anaesthesia
3. Caesarean sections
4. Hernia (inguinal or epigastric)
5. Piles fistulae & fissures
6. orthopaedic surgeries on the pelvis, femur, tibia and the ankle
7. nephrectomy
8. cholecystectomies
9. trauma surgery on the lower limbs, especially if the patient is full-stomach
10. Open tubectomies
11. Trans-urethral resection of prostate

Position- Lateral, Sitting or Prone.

Approach- Midline, Paramedian or Lumbosacral ( Taylor- 1 cm medial, 1 cm lateral to Posterior Superior Iliac Spine)

Space- L3-L4 or L4-l5

Site of action- Spinal Nerves and dorsal ganglia minimally on Spinal cord.

Drugs used-

Local Anaesthetics-

1. Xylocaine 5% in 7.5% Dextrose ( Hyperbaric 1.03333 spg)

2.Bupivacaine 0.5% in 8% dextrose

3. Tetracaine 1% in 5 D

4. Procaine 10% in 5D

Opioids

Ketamine

Needle Used- Duracutting- Quincke-Babcock and Greene  and Duraseparating -pencil tip point end ( Whitcre, Sporte and Pitkin)

Factors Affecting Block-

Volume, Baricity,Position of patient,Intra-abdominal pressure, Spinal curvature and factors like age,obesity and height

Complications

• * Spinal shock.
• * Cauda equina injury.
• * Cardiac arrest.
• * Hypothermia.
• * Broken needle.
• * Bleeding resulting in hematoma, with or without subsequent neurological sequelae due to compression of the spinal nerves
• * Infection: immediate within six hours of the spinl anaesthetic manifesting as meningism or meningitis or late, at the site of injection, in the form of pus discharge, due to improper sterilization of the LP set.
• * PDPH:post dural puncture head ache or post spinal head ache

Post-op: Urine Retention

Source : Youtube Video

Popularity: 11%

Tags: Anaesthesia, l3 l4, SAB, spinal anesthesia, spinal block procedure, video

Last updated: March 13, 2011

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