Selective Spinal Anesthesia: Unilateral and Posterior Techniques
Amr Mohammed Eltaher Abdelmonem Abdelhalim;
Abstract
The terms unilateral spinal anesthesia and selective spinal anesthesia overlap slightly, but both refer to small-dose techniques that capitalize on baricity and patient positioning to hasten recovery. In selective spinal anesthesia, minimal dose of local anesthetics are used with the goal of anesthetizing only the sensory fibers to a specific area.
Unilateral spinal analgesia, where anesthesia is restricted to one side of the body by the CSFinjection of hypobaric or hyperbaric solutions with the patient placed in the lateral position.
Lumbosacral nerves may be anesthetized in three different ways: The first, with patients lying in the lateral position; the second with patients in the sitting position, and finally, with patients is in the prone position. The site of sensory block spinal anesthesia is generally considered by blockade of the posterior roots (sensory). A practical definition of spinal hemi-anesthesia could be the attempt of achieving an asymmetrical distribution of spinal block between the operated and nonoperated sides of the patients.
Selective spinal anesthesia has been used as a reliable technique that offers a satisfactory alternative to general anesthesia for outpatient surgical procedures. Selective spinal anesthesia has the advantage of using minimal doses of conventional intrathecal anesthetic to obtain anesthesia of specific nerve roots and selective modalities. It provides selective pinprick anesthesia without affecting the motor functions, and maintains the integrity of the dorsal columns. Due to these reasons, Selective spinal anesthesia attain selective short duration spinal anesthesia and facilitates ambulation at the completion of the surgical procedure.
Various procedures have specific needs for selective spinal anesthesia, including procedures for one lower extremity, unilateral inguinal hernia repair, Ano-rectal or urological surgery and gynecological laparoscopy.
Despite the many years that selective spinal anesthesia have been used, there remain controversies about the appropriate use of these blocks. Some continue to suggest that this technique is inappropriate for outpatients because of the occurrence of post–spinal puncture headache, but there are data that the occasional headache can be successfully treated even in outpatients, and considerable other data support use of the technique in outpatients.
If a selective spinal anesthesia is being considered, the risks and benefits must be discussed with the patient, and informed consent should be obtained. The patient must be mentally prepared for neuraxial anesthesia, and neuraxial anesthesia must be appropriate for the type of surgery. Patients should understand that they will have little or no lower extremity motor function until the block resolves.
Unilateral spinal analgesia, where anesthesia is restricted to one side of the body by the CSFinjection of hypobaric or hyperbaric solutions with the patient placed in the lateral position.
Lumbosacral nerves may be anesthetized in three different ways: The first, with patients lying in the lateral position; the second with patients in the sitting position, and finally, with patients is in the prone position. The site of sensory block spinal anesthesia is generally considered by blockade of the posterior roots (sensory). A practical definition of spinal hemi-anesthesia could be the attempt of achieving an asymmetrical distribution of spinal block between the operated and nonoperated sides of the patients.
Selective spinal anesthesia has been used as a reliable technique that offers a satisfactory alternative to general anesthesia for outpatient surgical procedures. Selective spinal anesthesia has the advantage of using minimal doses of conventional intrathecal anesthetic to obtain anesthesia of specific nerve roots and selective modalities. It provides selective pinprick anesthesia without affecting the motor functions, and maintains the integrity of the dorsal columns. Due to these reasons, Selective spinal anesthesia attain selective short duration spinal anesthesia and facilitates ambulation at the completion of the surgical procedure.
Various procedures have specific needs for selective spinal anesthesia, including procedures for one lower extremity, unilateral inguinal hernia repair, Ano-rectal or urological surgery and gynecological laparoscopy.
Despite the many years that selective spinal anesthesia have been used, there remain controversies about the appropriate use of these blocks. Some continue to suggest that this technique is inappropriate for outpatients because of the occurrence of post–spinal puncture headache, but there are data that the occasional headache can be successfully treated even in outpatients, and considerable other data support use of the technique in outpatients.
If a selective spinal anesthesia is being considered, the risks and benefits must be discussed with the patient, and informed consent should be obtained. The patient must be mentally prepared for neuraxial anesthesia, and neuraxial anesthesia must be appropriate for the type of surgery. Patients should understand that they will have little or no lower extremity motor function until the block resolves.
Other data
| Title | Selective Spinal Anesthesia: Unilateral and Posterior Techniques | Other Titles | التخدير النصفي الانتقائي: التقنيات ذات الجانب الواحد والخلفية | Authors | Amr Mohammed Eltaher Abdelmonem Abdelhalim | Issue Date | 2016 |
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