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.
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.