SPINAL ANAESTHESIA

Spinal anaesthesia (SAB)

Vertebral column consists of:
 Cervical :7
 Thoracic : 12
 Lumber :5
 Sacral :5
 Coccygeal : 4-5

Curvatures
4 curvatures:
 2 primary (thoracic, sacral) : concave anteriorly
 2 secondary (cervical, lumber) : concave posteriorly

Spinal cord
 Extend from foramen magnum to:
 in adult : lower border of L1 or L1-L2 interspace
 in neonate : extends up to L3-L4
 Length: about 45 cm in male
 Meninges from outward to inward:
i) Dura mater
ii) Arachnoid mater
iii) Pia mater

Indications of Spinal Anaesthesia

A. Operative
1. Lower extremity
2. Perineum
3. Lower abdomen e.g. urinary bladder, lower ureter, prostate, LUCS etc.
B. Diagnostic

Contraindications to SAB
1. Bleeding disorder
2. Severe hypertension
3. Hypotension
4. Local skin infection
5. Patients on anticoagulant therapy
6. Pre-existing spinal cord disease
7. Patients refusal

MUSFIQUE
SPINAL ANAESTHESIA

Structures crossing during SAB if paramedian, supraspinous and infraspinous ligament are excluded
1. Skin
2. Subcutaneous tissue
3. Supraspinous ligament
4. Interspinous ligament
5. Ligamentum flava
6. Dura mater
7. Arachnoid mater

Complications of SAB
A. Immediate complications B. Late complications
1. Hypotension 1. Headache (PDPH)
2. Nausea 2. Backache
3. Vomiting 3. Retention of urine
4. Difficulty in phonation 4. Chronic adhesive arachnoiditis
5. Apnea
 Thoraco-lumber outflow is sympathetic hence when spinal anaesthesia is given in lumber region,
sympathetic nervous system is suppressed and vasodilatation occur causing hypotension.
 Preload is done prior to administration of spinal anaesthesia to increase blood pressure for this
reason which is not required in case of general anaesthesia.

Prevention & Management of Hypotension

1. Adequate IV fluid preload
2. Use of vasopressor ephidrine hydrochloride first choice

Drugs used
 Hyperbaric local anaesthetic agent
 it is used as level of block can be predicted

Management of Nausea & Vomiting

1. Oxygen supplementation
2. Control of blood pressure
3. Use of anti-emetics
4. Use of anti-cholinergic drug

Management of PDPH
1. Bed rest
2. Plenty of oral fluid intake
3. Analgesic
4. IV fluid
5. Epidural blood patch

MUSFIQUE