Gasbag Anaesthesia Forums

Anesthesia Discussion => Regional Anesthesia => Topic started by: MAGRO on March 14, 2007, 09:20:23 PM

Poll
Question: Is there Anyone who perform spinal anaesthesia in the prone position?
Option 1: spinal anaesthesia votes: 3
Option 2: prone position votes: 5
Title: prone spinal anaesthesia
Post by: MAGRO on March 14, 2007, 09:20:23 PM
I've performed spinal anaesthesia in the prone position in 60 patients for the spine surgery (i.e. lumbar disk erniation).
I 'ld like to discuss about this personal technique
Title: Re: prone spinal anaesthesia
Post by: kumar on March 16, 2007, 02:06:34 PM
wow i have never seen
Title: Re: prone spinal anaesthesia
Post by: swatantramishra on March 16, 2007, 04:41:23 PM
how are your results,did prone position affact the durstion of the block?
I've performed spinal anaesthesia in the prone position in 60 patients for the spine surgery (i.e. lumbar disk erniation).
I 'ld like to discuss about this personal technique
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Title: Re: prone spinal anaesthesia
Post by: MAGRO on March 17, 2007, 06:16:10 PM
My results confirm the personal opinion that subaracnoid anaesthesia is better tolerated when performed in the prone position than in the other usual known.
In this field I suggest everybody to chek the possibility to realize this simply tecnique.
More information about in the next congress on this topic.
Title: Re: prone spinal anaesthesia
Post by: lovebailey2000 on April 08, 2007, 06:20:19 PM
This is really smthing new n xciting! wud luv to know more about it.
Title: Re: prone spinal anaesthesia
Post by: MAGRO on April 09, 2007, 08:13:46 AM
Hello.I'm an italian anaesthesiologist,I took advantage for my revised prone spinal aanesthesia tecnique from my experience in the field of neurosurgery and spine surgery.
I'd like to be invited in scientific meetings to show my tecnique and the results.If u know te way please contact me.
The tecnique requires a god knowledge of anesthetica properties and a god experience in the spinal anaestesia .
I'd like to know in which institution uyou are gettin' your pratice.
many regards
Title: Re: prone spinal anaesthesia
Post by: lovebailey2000 on April 16, 2007, 12:44:08 PM
Hi
I really find this idea new and exciting! but still i doubt its superiority over the epidural block which will give excellant post-op pain relief also. I am working in India as a faculty in Government Medical College and wud like to know about the merits of this technique.
Regards
Title: Re: prone spinal anaesthesia
Post by: yogenbhatt1 on April 18, 2007, 12:16:14 PM
Yes, We have performed Spinal Anaesthesia in three patients, where it was very difficult to give spinal due to technical difficulties. For example, two were very obese and could not get any bearings to give spinal and one was a case of Polio deformity. We used a C- arm TV and under vesion we could give it.
Title: Re: prone spinal anaesthesia
Post by: Krishnendu Chaudhuri on May 29, 2007, 03:13:26 AM
Do you mean spinal anaesthesia for surgery in the prone position? I've done that. But I gave the spinal in lateral position
Title: Re: prone spinal anaesthesia
Post by: MAGRO on May 29, 2007, 10:06:49 AM
Prone spinal anaesthesia can be realized also for proctology surgery (perianal fistula) when the patient operative position required is the prone.
Try to do it and the patient with acute pain will be very satisfied and will give many compliments ti you.
Title: Re: prone spinal anaesthesia
Post by: Alireza on July 03, 2007, 06:14:47 PM
Hello everyone.i,m iranian anesthesilogist.in our hospital we perform pron position spinal a. for all of pilonidal cyct surgeries.

In this technique at first,we  position the patient in prone position then use 1µg/kg fentanyl+1-2mg midazolam as premed.Then we use often paramedian approach for needle insertion.i use ketamin in analgesic dose after midazolam premed. In some of cases.
I don,t use pron position SA. For disk herniation surgery.plz tell us more about this technique.
Title: Re: prone spinal anaesthesia
Post by: hillpeng on July 08, 2007, 01:51:11 PM
those methods all can suit in operation, based on your technology
Title: Re: prone spinal anaesthesia
Post by: dramitshah on July 10, 2007, 11:46:34 AM
well i am from Gujarat ,
and to my knowledge no one practice lumbar puncture in prone position.
spinal anesthesia is used for PCNL (percutaneous nephro lithotomy) , but LP is done in lateral or sitting position.
kindly give more details about technique and reference from literature if available .
can be of great help in such patients
Title: Re: prone spinal anaesthesia
Post by: MAGRO on July 14, 2007, 04:25:53 PM
Complete information and detail will be reported during ESRA MEETING in SALERNO (ITALY) the next October.
Title: Re: prone spinal anaesthesia
Post by: yogenbhatt1 on July 16, 2007, 02:21:13 AM
Hi,
I tried spinal anaesthesia in prone position after giving GA and then given a prone position. I just want to know whether CSF flows on its own or you have to aspirate to check. I had to aspirate. It worked well too.
Title: Re: prone spinal anaesthesia
Post by: jafo1964 on July 18, 2007, 04:51:23 PM
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
Title: Re: prone spinal anaesthesia
Post by: Alireza on July 20, 2007, 07:19:01 PM
http://[b]we%20already%20done%20prone%20position%20spinal%20a.%20with%20no.25%20needle%20and%20always%20the%20csfFlows%20on%20its%20own%20slowly%20in%20all%20of%20my%20cases.%20[/b]
Title: Re: prone spinal anaesthesia
Post by: MAGRO on July 23, 2007, 04:48:41 PM
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.
Title: Re: prone spinal anaesthesia
Post by: yogenbhatt1 on July 27, 2007, 03:10:53 PM
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.
Title: Re: prone spinal anaesthesia
Post by: MAGRO on August 24, 2007, 01:24:59 PM
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.
Title: Re: prone spinal anaesthesia
Post by: sony on September 18, 2007, 12:42:12 PM
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.
Title: Re: prone spinal anaesthesia
Post by: santoshkadam on September 19, 2007, 08:14:23 AM
SORRY   friends am not getting the topic is it spinal aneshesia after prone position or befor proneposition, please clarify it
Title: Re: prone spinal anaesthesia
Post by: George K on August 02, 2010, 02:51:30 AM
(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.
Title: Re: prone spinal anaesthesia
Post by: anaesami on August 02, 2010, 09:00:43 AM
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.
Title: Re: prone spinal anaesthesia
Post by: George K on August 02, 2010, 11:09:22 PM
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.

(https://www.gasbag.net/proxy.php?request=http%3A%2F%2Fwww.erothitan.com%2Fradiolucent_surgery_tables%2Fimages%2Fwilson.jpg&hash=599ac5e77a0dcd5a5de41b468b0589e8f2977d7b)


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.
Title: Re: prone spinal anaesthesia
Post by: yogenbhatt1 on August 29, 2010, 05:58:01 AM
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.
Title: Re: prone spinal anaesthesia
Post by: NOMOREGAS on September 06, 2010, 08:05:15 AM
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
Title: Re: prone spinal anaesthesia
Post by: yogenbhatt1 on April 10, 2011, 05:19:01 AM
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.
Title: Re: prone spinal anaesthesia
Post by: anesthesia_samar on February 26, 2014, 07:58:57 PM
useful disscusion .. thanks

http://www.fmed.bu.edu.eg/en/
http://www.fmed.bu.edu.eg/fmed/index.php/anet