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• spinal anaesthesia

  3 (37.5%)

  prone position

  5 (62.5%)

Total Members Voted: 8

[jafo1964]

Dr Yogen
I wonder why you opted for a spinal in a patient who was already under GA. What surgery can be better performed under Ga + spinal than GA alone

Purist may not approve of a spinal in the prone position. What if you have a total or high spinal needing resuscitation and intubation

On the other hand the Taylor's approach to SAB through the L5S1 space has also been defined in the prone position

[Alireza]

http://[b]We already done prone position spinal a. with no.25 needle and always the CSF
Flows on its own slowly in all of my cases. [/b]

[MAGRO]

Dear Collegue sometimes a smooth aspiration is needed,but u have to be patient ,seeing a drop of LCS in the needle is enough encouraging  u to injectate the anesthetic solution.

[yogenbhatt1]

Hi Jafo ,
Yes, I did try out a thing which I used to read in places. I thought  that may be the Oozing in the patient will be a bit lesser and we may enjoy the surgery a bit better. Any case the surgery out lasted the effect of 1.5 ml of Bupivacain 0.5%. Any case there was no difference in oozing . It lasted for 5 hours.
You are right , one should not try out such unnessary stunts.
Sorry about the late reply. The net was down for a long time.

[MAGRO]

About my personal tecnique,shorthening the time of postionong the patient,the cardiovascular changes are well tolerated and there is less cephalic spread of anestetics .
Both the surgeon and the patients are satisfied.

[sony]

sir, spinal in prone position was started long time back. i think the first spinal was given that way.but the hypotension can some time be very sever due to venous pooling in legs and chest.i give it in cases of pilonidal sinus excision. i keep 4-5 large pillows under abdomen to keep the spine bend.keep sedation to minimum so that patient can position himself. i mainly do it to keep the older nursing staff happy as they don't have to shift the patient prone. usually csf comes itself. but some time you have to aspirate.

[santoshkadam]

SORRY   friends am not getting the topic is it spinal aneshesia after prone position or befor proneposition, please clarify it

[George K]

(sorry to reply to an (almost) dead thread, but I have to get my 2¢ in.)

Back in the old days, when dinosaurs walked the Earth, I used to do hypobaric spinals in the prone position. I don't even remember the drug we used. It was a great anesthetic, however.

Now, in private practice, the goal is to get the patients home as quickly as possible, and everyone gets a general.

[anaesami]

would someone please post the details of the technique with pictures please or give info on where i can get it? details regarding the positioning, difficulties encountered if any, the level of block achievable etc etc would be welcome.

[George K]

You're jostling some very old memories!

We did these for hemorrhoidectomies. The patient would position him/her self onto a Wilson frame (used for laminectomies). This position afforded the right amount of curve to the lumbar spine to make lumbar puncture (a bit) easier. We would perform the LP, and you have to aspirate to get CSF, and inject the drug. Because the patient was in a bit of head-down position, the block get the anal, sacral areas.




If I recall correctly, we used tetracaine, diluted with sterile water to render it hypobaric.

Of course, now, 20 years later, I don't remember the last time I used tetracaine.

[yogenbhatt1]

HI,
At times the lumber discoidectomy is done in Jack-Knife position.
Here, the chances of the drug going cephaloid, is very high due to gravity.
Have you ever thought of Ropivacain Isobaric? It will stay where it is , as gravity does not act on it.
I will try when possible and give a feed back,
Regards.

[NOMOREGAS]

i AGRRE WITH YOU ABOUT THE ROPIVACAINE PROPERTIES;HOWEVER IN MY COUNTRY (ITALY) ROPIVACAINE INTRATHECAL IS NON REGISTERED AND  ALLOWED.
I EXPECT A FEDD BACK FOM U SOON.
MAGRO

[yogenbhatt1]

Have given Spinal in Prone, Specially for Spine. But I have seen ppl having burnt hands as the level goes high due to Thorecic curve, and also afraid to use if my surgeon likes Jack-Knife position. That is why I like to use Isobaric Ropivacain. It does not go high or low with Postural changes.