Regional Anes
Regional Anes
Regional Anes
ANESTHESIA
33 Vertebrae
◦ 7 Cervical
◦ 12 Thoracic
◦ 5 Lumbar
◦ 5 Sacral
◦ 4 Coccygeal
Spinal Cord
– Adult
• Begins: Foramen Magnum
• Ends: L1
– Newborn
• Begins: Foramen Magnum
• Ends: L3
– Terminal End: Conus
Medullaris
– Filum Terminale:
Anchors in sacral region
– Cauda Equina: Nerve
group of lower dural sac
Epidural Space
• Skin
• Subcutaneous tissue
• Supraspinous ligament
• Interspinous ligament
• Ligamentum flavum
• Epidural space
• Dura
• Subarachnoid space
PHYSIOLOGIC CHANGES
• Technique:
• Loss of resistance technique to identify the epidural
space.
• 0.5% Bupivacaine (mainly) or lidocaine (2.0%) is usually
used to produce epidural anaesthesia.
Advantages
• SPINAL • EPIDURAL
ANESTHESIA ANESTHESIA
• Sepsis
• Uncooperative patient
• Pre-existing neurologic deficits
• Stenotic valvular heart lesions
• Severe spinal deformity
SPINAL ANESTHESIA
• “4 P’s”:
1. Preparation
2. Position
3. Projection
4. Puncture
SPINAL ANESTHESIA TECHNIQUE
1. PREPARATION:
- Preparation of equipment/ medications is the first step.
• Discuss the options for anesthesia.
-risk and benefits
• Choose an appropriate local anesthetic
• Choose the appropriate spinal needle
2. Positioning
. ANATOMICAL LANDMARK:
ANTERIOR SUPERIOR ILIAC SPINE
• 2. Palpation in the
midline should help to
identify the
interspinous ligament.
The extent of the space
is noted by palpating the
cephalad and caudad
spine. The midline is
noted by moving your
fingers from medial to
lateral.
3. Wash hands, put on sterile gloves, use
sterile technique.