Spinal anesthesia: Technique
- Alexander M DeLeon, MD
Alexander M DeLeon, MD
- Assistant Professor in Anesthesiology
- Northwestern University
- Cynthia A Wong, MD
Cynthia A Wong, MD
- Professor of Anesthesia
- University of Iowa Healthcare
Spinal anesthesia is a type of neuraxial anesthesia; local anesthetic (LA) is injected into cerebrospinal fluid (CSF) in the lumbar spine to anesthetize nerves that exit the spinal cord. Spinal anesthesia is most commonly used for anesthesia and/or analgesia for a variety of lower extremity, lower abdominal, pelvic, and perineal procedures.
This topic will discuss the relevant anatomy, techniques, and management of spinal anesthesia.
Techniques for other types of neuraxial anesthesia, including epidural and combined spinal-epidural, are discussed separately. (See "Overview of anesthesia and anesthetic choices" and "Neuraxial analgesia for labor and delivery (including instrumented delivery)", section on 'Epidural analgesia technique' and "Neuraxial analgesia for labor and delivery (including instrumented delivery)", section on 'CSE analgesia'.)
Spinal anesthesia is performed by placing a needle between the lumbar vertebrae and through the dura to inject anesthetic medication. Anatomy of the bony spine and vertebrae are discussed in more detail separately (figure 1 and figure 2). (See "Spinal column injuries in adults: Definitions, mechanisms, and radiographs", section on 'Anatomy'.)
Anatomy related specifically to the performance of spinal anesthesia is discussed here.
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- PREOPERATIVE EVALUATION
- Preparation for spinal anesthesia
- Positioning for spinal procedure
- Preprocedure ultrasonography
- Aseptic technique
- Choice of spinal needle
- - Midline approach technique
- - Paramedian approach technique
- Spinal injection
- Post-injection positioning
- Continuous spinal
- Choice of spinal drugs
- - Baricity
- - Local anesthetics
- - Adjuvants
- MANAGEMENT AFTER SPINAL INJECTION
- Hemodynamic management
- Assessment of level of block
- Sedation during spinal anesthesia
- SUMMARY AND RECOMMENDATIONS