Figure 123-1. Needles Used for Spinal Anesthesia
Reproduced from Hadzic A. The New York School of Regional Anesthesia Textbook of Regional Anesthesia and Acute Pain Management. Figure 13-10. Available at: www.accessanesthesiology.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.
- All have a stylet to avoid tracking epithelial cells into the subarachnoid space
- Quincke is cutting needle with end injection
- Whitacre, Sprotte, Pencan are pencil-point (rounded points and side injection)
- Sprotte has long opening, more vigorous CSF flow but possible failed block if distal part of opening is subarachnoid (with free flow CSF), but proximal part is not past dura and the full dose of medication is not delivered
- Blunt tip (pencil-point) needles and small-gauge needles decrease the incidence of postdural puncture headache
Dosages, Uses, and Duration of Commonly Used Spinal Anesthetic Agents
|2-Chloroprocaine||1%, 2%, 3%||30–60||Ambulatory, T8||1–2||Not recommended (flu-like symptoms)|
|Lidocaine||2%||40–50||Ambulatory, T8||1–2||Only modest effect, not recommended|
|Mepivacaine1||1.5%||30 (T9)||Ambulatory surgery, knee scope, TURP||1–2||Not recommended|
|Bupivacaine||0.5%||7.5||Ambulatory lower limb||1–2|
|10||THA, TKA, femur ORIF||2|
|Bupivacaine||0.75% in 8.25% dextrose||4–10||Perineum, lower limbs3||1.5–2||1.5–2.5|
|Ropivacaine||0.5%, 0.75%||15–17.5||T10 level||2–3||Does not prolong block|
|1% + 10% dextrose (equal volumes D10 and ropivacaine)||18–22.5||T4 level||1.5–2|
|Tetracaine||1% + 10% dextrose (0.5% hyperbaric)||4–8||Perineum/lower extremities||1.5–2||3.5–4|
Common Adjuvants to Spinal Anesthetics
|Adjuvant||Dose (μg)||Duration (h)||Comments/side effects|
|Fentanyl||10–25||1–2||Itching; nausea; urinary retention; sedation; ileus; respiratory depression (delayed with morphine—↓ dose with elderly or sleep apnea)|
|Epinephrine||100–200||Prolongs nerve exposure to local anesthetic + alpha-adrenergic modulation|
|Phenylephrine||1,000–2,000||Hypotension. Prolongs tetracaine but not bupivacaine. Extends tetracaine better than epinephrine does. May cause TNS|
|Clonidine||15–150||Hypotension. Sedation. Prolongs motor and sensory block|
- After sterile prep, drape, and local infiltration of skin:
- Advance introducer (not necessary for 22G Quincke needle)
- Advance spinal needle through ...
Please Try Again Later
Your institution has exceeded the maximum number of simultaneous users. Please try later.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
Create a Free MyAccess Profile
Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.
Benefits of a MyAccess Profile:
- Remote access to the site off-campus on any device
- Notification of new content via custom alerts
- Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
- Save and download images to PowerPoint
- Self-Assessment quizzes saved for quick review
- Custom Curriculum access for both instructors and learners
AccessAnesthesiology Full Site: One-Year Subscription
Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more
Pay Per View: Timed Access to all of AccessAnesthesiology
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.