Anaes · Neuraxial anaesthesia
Spinal (intrathecal) anaesthesia
Also known as Spinal anaesthesia · Subarachnoid block · Intrathecal anaesthesia · Spinal block · Single-shot spinal · Hyperbaric bupivacaine spinal
Spinal anaesthesia is the injection of a small dose of local anaesthetic into the cerebrospinal fluid of the subarachnoid space to produce a rapid, dense and predictable block of the sensory, motor and sympathetic nerves that the solution reaches. It is the standard anaesthetic for lower-body surgery and caesarean section, and its mastery rests on the anatomy of the neuraxial approach, the determinants of block height, the physiology of the sympathetic block and its hypotension, and the prevention and management of the post-dural puncture headache and the high spinal.
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8 MCQs with explanations
Target exams
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Meet the patient
A 32-year-old woman arrives for an elective caesarean. You sit her up, raise a wheal of 1 percent lidocaine, and pass a 27-gauge pencil-point needle into the subarachnoid space at L3/L4. Clear CSF flows. You inject 12.5 milligrams of hyperbaric bupivacaine with 15 micrograms of fentanyl, turn her supine with a left wedge, and start a phenylephrine infusion. Within ten minutes she is numb to T4 and comfortable; her baby is delivered awake and her systolic never strays far from baseline.[1]
That case is the synthesis of the whole topic: a small dose into the CSF, the baricity shaped by position, the hypotension anticipated by a co-load and a vasopressor, and the complications prevented by a fine pencil-point needle. Master those four and you have the spinal.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Anaesthesia fellowship atlas.
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- [1]Ferré F, Martin C, Bosch L, et al. Control of Spinal Anesthesia-Induced Hypotension in Adults Local Reg Anesth, 2020.PMID 32581577
- [2]Lee A, Ngan Kee WD, Gin T A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery Anesth Analg, 2002.PMID 11916798
- [3]Veeser M, Hofmann T, Roth R, et al. Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis Acta Anaesthesiol Scand, 2012.PMID 22313496
- [4]Ngan Kee WD, Lee SWY, Ng FF, Khaw KS Prophylactic Norepinephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery Anesth Analg, 2018.PMID 28678073
- [5]Palmer CM, Emerson S, Volgoropolous D, Alves D Dose-response relationship of intrathecal morphine for postcesarean analgesia Anesthesiology, 1999.PMID 9952150
- [6]Sachs A, Smiley R Post-dural puncture headache: the worst common complication in obstetric anesthesia Semin Perinatol, 2014.PMID 25146108
- [7]Cook TM, Counsell D, Wildsmith JA; Royal College of Anaesthetists Third National Audit Project Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists Br J Anaesth, 2009.PMID 19139027
- [8]Leffert L, Butwick A, Carvalho B, et al The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants Anesth Analg, 2018.PMID 29099429
- [9]Uppal V, Shanthanna H, Prabhakar C, McKeen DM Intrathecal hyperbaric versus isobaric bupivacaine for adult non-caesarean-section surgery: systematic review protocol BMJ Open, 2016.PMID 27194318