Spinal anaesthesia technique DR KHANALIHA Technique Preparation Position

Spinal anaesthesia technique DR. KHANALIHA

Technique Preparation Position Projection Puncture

Preparation Equipment Resuscitation Monitoring Packs(swabs, towels, syring, fi lters) Needles Drugs

Needles Cutting( Pitkin- Quinke ) Pencil point needles(Sporte – Whitacare …) Touhy for continuous spinal PDPH 40% with needle size 22 ----2% with 29 size) Optimum needles are 25 -26 -27 pencil point needles

Sterility Face mask ( streptococcus viridance is the most common organism for meningitis) Hand washing Cleaning &antisepsis( chlorhexidine – alcohol- iodine solution) Drape with fenestrated shawn

Position Sitting Lateral decubitus Prone Heavy sedation is not good specially in sitting position

Projection Spinal cord lower level is. L 1 L 2 Selective levels are. L 2 -L 3, L 3 -L 4, L 4 L 5 Tuffier s line cross the l 4 body or L 4 L 5 level

Procedure Midline approach Select the level & make a local anesthetic wheal Insert the introducer in 10 -15 cephalic direction Insert the neesle like a dart until puncture the dura Inject ing the drug by 0. 2 ml/sec speed Para median approach the alternative for midline approach ( needle insert from 1 cm lateral &1 cm lower point from midline and direct 10 -15 degree medial and cephalic direction)

Continouse spinal anesthesia Hemodynamic stability by incremental dose Catheter must never be withdrawan Useful in AS, cardiac disease in pregnancy , morbid obesity after spinal surgery Cauda equina syndrome with microcatheter Needle with lateral facing opening Catheter over the needle devices Catheter threaded 2 -3 cm into SA space Sterility is very important

Unilateral spinal anesthesia Use of baricity & patient position Knee arthroplasty with 4 -5 mg bupivacaine Inguinal hernia repair with 8 mg bupivacaine