Spinal anaesthesia techniqueDR .KHANALIHA

Technique

Projection

Position

Preparation

Puncture

Preparation

Monitoring

Resuscitation

Drugs

Needles

Packs(swabs,towels,syring,filters)

Equipment

NeedlesCutting( Pitkin- Quinke

)

Touhy for continuous spinal

Pencil point needles(Sporte –Whitacare

…)

PDPH 40% with needle size 22 ----2% with 29 size)

Optimum needles are 25-26-27 pencil point needles

SterilityFace mask ( streptococcus viridance is the most common

organism for meningitis)

Drape with fenestrated shawn

Cleaning &antisepsis( chlorhexidine –

alcohol- iodine solution)

Hand washing

Position Sitting

Prone

Lateral decubitus

Heavy sedation is not good specially in sitting position

Projection

Spinal cord lower level isL1-L2

Tuffier s line cross the l4 body or L4-L5level

Selective levels areL2-L3,L3-L4,L4-L5

Procedure

Select the level & make a local anesthetic wheal

Inject ing the drug by 0.2 ml/sec speed

Insert the neesle like a dart until puncture the dura

Insert the introducer in 10-15 cephalic direction

Para median approach the alternative for midline approach ( needle insert from 1cm lateral &1cm lower point from midline and

direct 10 -15 degree medial and cephalic direction)

Midline approach

Continouse spinal anesthesia

Hemodynamic stability by incremental dose

Catheter threaded 2-3cm into SA space

Useful in AS,cardiac disease in pregnancy ,morbid obesity after

spinal surgery

Needle with lateral facing opening

Cauda equina syndrome with microcatheter

Catheter must never be withdrawan

Catheter over the needle devices

Sterility is very important

Unilateral spinal anesthesia

Use of baricity & patient position

Knee arthroplasty with 4-5 mg bupivacaine

Inguinal hernia repair with8 mg bupivacaine