Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ See 57262378. ++Figure 123-1. Needles Used for Spinal AnesthesiaGraphic Jump LocationView Full Size||Download Slide (.ppt)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 spaceQuincke is cutting needle with end injectionWhitacre, 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 deliveredBlunt tip (pencil-point) needles and small-gauge needles decrease the incidence of postdural puncture headache ++ See following table. ++Table Graphic Jump Location|Download (.pdf)|PrintDosages, Uses, and Duration of Commonly Used Spinal Anesthetic AgentsDuration (h)DrugPreparationDose (mg)ProceduresPlainEpinephrine2-Chloroprocaine1%, 2%, 3%30–60Ambulatory, T81–2Not recommended (flu-like symptoms)Lidocaine2%40–50Ambulatory, T81–2Only modest effect, not recommendedMepivacaine11.5%30 (T9)Ambulatory surgery, knee scope, TURP1–2Not recommended45 (T6)21.5–360 (T5)2–3.5Bupivacaine0.5%7.5Ambulatory lower limb1–210THA, TKA, femur ORIF21534–5Bupivacaine0.75% in 8.25% dextrose4–10Perineum, lower limbs31.5–21.5–2.512–14Lower abdomen12–18Upper abdomenRopivacaine0.5%, 0.75%15–17.5T10 level2–3Does not prolong block18–22.5T8 level3–41% + 10% dextrose (equal volumes D10 and ropivacaine)18–22.5T4 level1.5–2Tetracaine1% + 10% dextrose (0.5% hyperbaric)4–8Perineum/lower extremities1.5–23.5–410–12Lower abdomen10–16Upper abdomen1Used 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. ++Table Graphic Jump Location|Download (.pdf)|PrintCommon Adjuvants to Spinal AnestheticsAdjuvantDose (μg)Duration (h)Comments/side effectsFentanyl10–251–2Itching; nausea; urinary retention; sedation; ileus; respiratory depression (delayed with morphine—↓ dose with elderly or sleep apnea)Sufentanil1.25–51Morphine125–2504–24Epinephrine100–200Prolongs nerve exposure to local anesthetic + alpha-adrenergic modulationPhenylephrine1,000–2,000Hypotension. Prolongs tetracaine but not bupivacaine. Extends tetracaine better than epinephrine does. May cause TNSClonidine15–150Hypotension. 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 ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.