Spinal Anesthesia

DEFINITION

Spinal anesthesia:
Injection of small amounts (2-3 ml) of local anesthetics into the CSF at the level below (L2), where the spinal cord ends, anesthesia of the lower body part below the umbilicus is achieved.

Indication

• Operations below the umbilicus:
  • hernia repairs
  • gynaecological
  • urological operation
  • orthopedics
• Any operation on the perineum or genitalia.

SPINAL ANESTHESIA

Complications

• Epidural hematoma
• Epidural abscess
• Meningitis
• Cauda equina
• Neurological deficit
• TNS
• Bradycardia--- Cardiac arrest
• HYPOTENSION

Treatment

• Best way to treat is physiologic not pharmacologic
• Primary Treatment
  • Increase the cardiac preload
    • Large IV fluid bolus within 30 minutes prior to spinal placement, minimum 1 liter of crystalloids
• Secondary Treatment
  • Pharmacologic
  • Ephedrine

SPINAL ANESTHESIA

Contraindications

• Refusal
• Infection
• Coagulopathy & anticoagulated patient
• Severe hypovolemia
• Increased intracranial pressure
• Severe aortic or mitral stenosis

Sterility

• Sterility

Sitting Vs. Lateral decubitus

SPINAL TECHNIQUE

• Midline Approach
  • Skin
  • Subcutaneous tissue
  • Supraspinous ligament
  • Interspinous ligament
  • Ligamentum flavum
  • Epidural space
  • Dura mater
  • Arachnoid mater
• Paramedian or Lateral Approach
  • Same as midline excluding supraspinous & interspinous ligaments