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See 57262378.

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: 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

See following table.

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Dosages, Uses, and Duration of Commonly Used Spinal Anesthetic Agents
Duration (h)
DrugPreparationDose (mg)ProceduresPlainEpinephrine
2-Chloroprocaine1%, 2%, 3%30–60Ambulatory, T81–2Not recommended (flu-like symptoms)
Lidocaine2%40–50Ambulatory, T81–2Only modest effect, not recommended
Mepivacaine11.5%30 (T9)Ambulatory surgery, knee scope, TURP1–2Not recommended
45 (T6)21.5–3
60 (T5)2–3.5
Bupivacaine0.5%7.5Ambulatory lower limb1–2
10THA, TKA, femur ORIF2
Bupivacaine0.75% in 8.25% dextrose4–10Perineum, lower limbs31.5–21.5–2.5
12–14Lower abdomen
12–18Upper abdomen
Ropivacaine0.5%, 0.75%15–17.5T10 level2–3Does not prolong block
18–22.5T8 level3–4
1% + 10% dextrose (equal volumes D10 and ropivacaine)18–22.5T4 level1.5–2
Tetracaine1% + 10% dextrose (0.5% hyperbaric)4–8Perineum/lower extremities1.5–23.5–4
10–12Lower abdomen
10–16Upper abdomen

1Used as an alternative to lidocaine, but TNS also occurs with mepivacaine.

2Each change of 15 mg prolongs or hastens ambulatory milestones by 20–30 minutes. Fentanyl 10 μg extends surgical block but not ambulatory recovery times and should probably be added if using 30 mg dose to ensure adequate duration.

3Very low dose (4–5 mg) works well for ambulatory, unilateral, knee surgery. Keep patient lateral, affected side down, for 6 minutes after block.

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Common Adjuvants to Spinal Anesthetics
AdjuvantDose (μg)Duration (h)Comments/side effects
Fentanyl10–251–2Itching; nausea; urinary retention; sedation; ileus; respiratory depression (delayed with morphine—↓ dose with elderly or sleep apnea)
Epinephrine100–200Prolongs nerve exposure to local anesthetic + alpha-adrenergic modulation
Phenylephrine1,000–2,000Hypotension. Prolongs tetracaine but not bupivacaine. Extends tetracaine better than epinephrine does. May cause TNS
Clonidine15–150Hypotension. 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 two “pops” (penetration of ligamentum flavum at ...

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