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 ...
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