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Author Topic: Unilateral spinals  (Read 3881 times)

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Walter Petorski

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Unilateral spinals
« on: January 20, 2005, 09:30:12 AM »
I'm amazed more anesthesiologists do not use this more often. I have used it since my resident days.

Solution used is 0.5% heavy bupivacaine. Patinet positioned on injured side down. You may need a few mL of propofol to get the patient into this position. Needle is a pencil point with a side opening.  Once a dural puncture is acheived, orientate the opening of the needle down (the opening usually corresponds with a little tab on the flange). Then inject the LA SLOWLY to avoid a jet effect - just let the LA sink slowly down. Then, most important, keep the patient on the injured side down for at least 15 and preferably 30 minutes. Once the propofol wears off, the block is effective and the patient is comfortable.

Advantages: almost complete unilateral block. Less hypotension as half the sympathetics are preserved.
« Last Edit: January 20, 2005, 01:37:50 PM by Robert Lang »
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gasman

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Re: Unilateral spinals
« Reply #1 on: January 20, 2005, 01:38:22 PM »
I also use this a lot. A minor disadvantage is  for orthopedic procedures where the other leg is swung out of the way of the X-Ray, patient may complain of pain/stiffness in that leg with a prolonged operation
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Dr.Rengarajan M.D

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Re: Unilateral spinals
« Reply #2 on: November 22, 2005, 12:07:47 AM »
We in India operate on an average 5-8 cases per day.My only problem is time constraint.I feel the advantage is not that great.hypotension can be easily managed.
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combest

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Re: Unilateral spinals
« Reply #3 on: February 07, 2006, 11:00:25 AM »
I have done this several times and find it to be very helpful.  Often, I had very elderly people come in with broken hips and would give about 20mg of ketamine to help them through the pain of lying on their broken hip for the placement of the SAB.  I, too, let the LA drip very slowly.  We would wait about 5-10 minutes and then move the pt to the OR table.  I did see some spread to the contralateral side, but not much.  Waiting for 30 minutes is not really an option for me either.   But I do see a difference in the hemodynamic control in these frail, easily compromised elderly people.
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frontier

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Re: Unilateral spinals
« Reply #4 on: January 09, 2007, 04:56:59 PM »
hi, 
 i am dr.simant wring from ranchi,india.i have given  a lot of unilateral spinal anaesthesia in orthopedic cases ,cholecystectomy,appendicectomy.advantage is minimal sympatholysis,minimal use of vasopressors like ephedrine,lesser amount of iv fluid to be used.it has got a definite advantage in case of elderly people,IHD cases where you have to use ephedrine in minimal doses.you will avoid unnecessary hypotension to be managed.so,it has got clearcut advantage.
« Last Edit: February 07, 2007, 08:02:42 PM by drsimant »
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carmanucor

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Re: Unilateral spinals
« Reply #5 on: January 10, 2007, 11:44:01 AM »
In ortopedic surgery ( hip trauma ), first I perform a femural block, with 25 ml of ropivacaíne 0.5% and 10 or 15 minutes later I  perform a SAB, with a bupivacaíne isobaric ( 7,5 mg ) and fentanil 12,5 ug , with the fractured hip upperside with no problem, and no hypotension. Sorry my bad English
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frontier

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Re: Unilateral spinals
« Reply #6 on: January 10, 2007, 05:47:56 PM »
hi, carmanucor,
                  you are very right.you are performing femoral block before giving spinal block.it means lesser doses of bupivacaine needed,so less hypotension obviously.if you perform only spinal block without tilting the patient then there will be profound hypotension.here discussion is going on regading spinal block without the help of other nerve blocks.thank you
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lovebailey2000

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Re: Unilateral spinals
« Reply #7 on: April 09, 2007, 04:31:28 AM »
Hi
  I have also used u/l spinals in elderly, frail patients, but only in strictly u/l procedures as in orthopedics, not in appendicectomis, as there may be a need of b/l blocks sometimes. And yes, u/l blocks were better hemodynamically.
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dr_ktg

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Re: Unilateral spinals
« Reply #8 on: July 01, 2007, 04:18:54 PM »
i have given many  unilaterals but in ortho pts the other leg has to be put in lithotomy position  which will be painful to pts
thanks
dr k t george
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