Spinal Anesthesia
Objective
To provide reversible anesthesia for
procedures and surgical interventions in the pelvic region and lower
extremities (like urological, gynecological, obstetrical, surgical and
orthopedic cases) by giving local anesthetics into the subarachnoid space.
Written
consent for procedure required.
Position
• Performed in sitting
posture
• Making the patient sit on
the operating table and placing the feet on a stool. Patient’s forearms on the
thighs. Lateral decubitus position patient lying on the side with hips and
knees maximally flexed
• Assistant stands in front
of the patient to help in maintaining the patient in a comfortable curled
position
• The main aim of proper
positioning is to obtain maximum flexion of the lumbar spine (Figs 4.2A to D).
Procedure on a Tiltable Table
1. Patient adequately
prepared, procedure fully explained; oral premedication given (Tablet Diazepam
5-10 mg - orally 90 minutes prior to procedure).
2. Intravenous line started
and preload with 500 ml of 5% dextrose in water or Ringer’s lactate solution.
3. ECG, NIBP, SpO2 - monitoring attached to the patient.
4. Scrub and wear sterile gown and gloves.
5. Check the spinal equipment on the sterile
trolley like the items required; proper size needle and stylet. Tip of stylet
should not project out from needle.
6. Read the label of local anesthetic to be
injected into CSF-for name, percentage, expiry date. Confirm it with another
person. Draw this into a 5 ml syringe.
7. Fill the local anesthetic to be used for skin
infiltration into a 2 ml syringe.
8. Cover the drug tray with sterile towel to
avoid contamination during cleaning.
9. Clean the patient’s back with antiseptic swabs
(savlon, iodine and spirit).
10. Swab eliptically from the proposed site
radially outwards; cephalad to caudal direction (Fig. 4.2).
11. Sufficiently large area is cleaned.
12. Allow the iodine to dry on the skin.
13. If the glove is smeared with antiseptic,
change them.
14. Drape the area with sterile towels.
15. Highest point of iliac crest palpated and
corresponding level (L4) space located (Fig. 4.2A).
16. At the proposed L4 space raise an intradermal wheel with local
anesthetic with a disposable 25 G needle.
17. Spinal needles are 8-10 cm long and each
needle is provided with a stylet.
18. The distal end of spinal needle is sharp and
short bevelled.
19. The size varies from 20 G to 26 G.
20. Thin needles are difficult to insert sometime
so introducer used.
21. Introducers are short length, thick needle
with or without flange.
22. Insert the introducer if using a thin 24-25
gauge needle upto interspinous ligament.
23. Insert the spinal needle through the
introducer into the space.
24. Increased resistance will be felt as the needle enters the
ligamentum flavum followed by loss of resistance in epidural space.
25. Advance the needle further, another loss of resistance as the dura
is pierced.
26. Stylet is removed from the needle and CSF flow is observed
27. Spinal needle is secured firmly by resting the back of left hand on
the patients’ back and using the thumb and index finger to hold the hub of
needle.
28. Attach the syringe with appropriate quantity of drug to be injected
into CSF.
29. Aspirate gently to check the needle position and inject the local
anesthetic.
30. After injection, withdraw the needle, introducer (if used) and the
syringe.
31. Apply sterile dry gauze over the puncture site and cover it with
sticking plaster.
32. Patient placed supine on the table.
33. Onset of action within few seconds.
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