SPINAL ANAESTHESIA :MODIFICATION OF TECHNIQUE FOR ROTATED SPINE
Spinal anaesthesia is a standard technique of making the lower half of the body numb by injecting anaesthetic drugs into the CSF by an injection in the lower back.This will allow all the surgeries on lower limbs and lower part of abdomen below the umbilicus.Routinely the spine is straight when viewed from back.The spinal needle is inserted in mid-line in lower back(L3-L4 SPACE) after ensuring that the patients are comfortable with either light sedation or local infiltration of xylocaine.
We get old age patients for various urological procedures like laser prostate,bladder tumour etc.Many a time they would have some spine problem in the past resulting in altered curvature of the vertebral column.In such cases, we review the spine alignment in two views by digital x-ray pre-operatively to predict the difficulty in administering the spinal anaesthesia.Spinal anaesthesia is much safer form of anaesthesia for surgeries on lower abdomen as it avoids multiple drugs (as needed for general anaesthesia) and maintains good haemodynamics after following all safe anaesthesia protocols.
Spinal anaesthesia is a blind technique and has to rely on only the feel of GIVE WAY of dura mater while doing the procedure. It is only by experience one can know the site of puncture and angulation to get a succesful lumbar puncture for spinal anaesthesia.There are two positions to perform the procedure, one is in sitting position and the other is in lateral position.The advantage of sitting position is it will correct some pre-existing minor spine rotations for succesful dural puncture.Also the drug injected is either sensorcaine heavy(0.5%) or xylocaine heavy(5%) which will gravitate to lower part of spine making the block localised to perineum(the area of surgery for prostate).
Spinal anaesthesia is a standard technique of making the lower half of the body numb by injecting anaesthetic drugs into the CSF by an injection in the lower back.This will allow all the surgeries on lower limbs and lower part of abdomen below the umbilicus.Routinely the spine is straight when viewed from back.The spinal needle is inserted in mid-line in lower back(L3-L4 SPACE) after ensuring that the patients are comfortable with either light sedation or local infiltration of xylocaine.
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| Position of patient for spinal anaesthesia. |
Spinal anaesthesia is a blind technique and has to rely on only the feel of GIVE WAY of dura mater while doing the procedure. It is only by experience one can know the site of puncture and angulation to get a succesful lumbar puncture for spinal anaesthesia.There are two positions to perform the procedure, one is in sitting position and the other is in lateral position.The advantage of sitting position is it will correct some pre-existing minor spine rotations for succesful dural puncture.Also the drug injected is either sensorcaine heavy(0.5%) or xylocaine heavy(5%) which will gravitate to lower part of spine making the block localised to perineum(the area of surgery for prostate).
As seen in this picture there is excessive scoliosis and rotated spine where we modified the lumbar puncture technique of mid-line puncture to PARA-MEDIAN puncture with cephalad angulation to get succesful dural puncture and surgery (laser prostate) was uneventfully completed.
Thanks for sharing the information about the spinal anesthesia .Long hour working style in the same position is the mail cause of the problem. people have need to need take care about that .
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