Sunday, April 18, 2021

Spinal Anesthesia

Spinal Anesthesia

Gloves, Povidone iodine, Spirit, Drape, Local anaesthesia kit, 18G needle, 25G dura splitting spinal needle, Bupivacaine/fentanyl/Lignocaine 

PREPARATION: Clean skin of back with povidone-iodine followed by alcohol and
drape the back of patient.

POSITION: Given so as to increase the distance between two spinous processes.

SITE: It is given in midline @ L3-L4 or L4-L5 level (horizontal line passing between the 2 iliac crests passes through L4 spinous process)

• Local anesthesia should be injected at the site.
• An 18 G introducer directed 10-15 degree cephalad (because spinous processes are directed downwards from the spine) up to interspinous ligament is introduced and stabilized with one hand.
• With the other hand, a 25 G dura splitting spinal needle (with stylet) is then passed through the introducer till subarachnoid space is entered (recognized by 2nd 'loss of resistance' feeling).
• NOTE: Introducer may not be required for thin needles like 25G needle.
• Stylet is then removed and CSF appears at the hub.
• Syringe with local anesthestic is then attached to the spinal needle while
holding it stable.
• Aspirate to see free flow of CSF and then inject the drug.

DRUGS USED COMMONLY : Bupivacaine, Lignocaine, Fentanyl 

LEVEL OF ANAESTHESIA : Checked by pinching skin by forceps


If still no CSF appears, ask a senior.


If blood clots in the needle, use another needle. 

3) If patient complains of sudden shooting pain in one leg (due to nerve injury by needle), move the needle medially.

Written by our guest authors: Krishna Borse and Anveshi Nayan
Illustrations by Anveshi Nayan and Ayushi Gupta

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