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Local Anesthetics: Clinical Application as Spinal Anesthesia

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...

Local Anesthetics: Clinical Application as Epidural Anesthesia

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...

Blood and Nerve Supply to the Bones

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Nutrient Artery
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Local Anesthetics: Differential Sensitivity of Nerve Fibers

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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...

Spinal Nerves: Plexus I

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In Vivo SiRNA Transfection and Gene Knockdown in Spinal Cord via Rapid Noninvasive Lumbar Intrathecal Injections in Mice

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Published on: March 22, 2014

Does a paresthesia during spinal needle insertion indicate intrathecal needle placement?

Ryan P Pong¹, Benjamin S Gmelch, Christopher M Bernards

¹Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA 98101-2756, USA.

Regional Anesthesia and Pain Medicine

|March 5, 2009

Summary

Transient paresthesias during spinal anesthesia often indicate needle contact with a spinal nerve root in the subarachnoid space. Confirming cerebrospinal fluid (CSF) presence is crucial for proper needle management.

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Published on: October 29, 2019

Area of Science:

Anesthesiology
Neurosurgery
Spinal Procedures

Background:

Paresthesias during spinal needle insertion are common but their clinical significance remains unclear.
Potential causes include needle contact with spinal nerves in the epidural space, intervertebral foramen, or subarachnoid space.

Purpose of the Study:

To investigate the hypothesis that paresthesias during spinal anesthesia are caused by needle contact with spinal nerve roots within the subarachnoid space.

Main Methods:

104 patients undergoing spinal anesthesia were observed during needle insertion.
If paresthesia occurred, the needle was stabilized, and the stylet removed to check for cerebrospinal fluid (CSF) flow.
Presence of CSF confirmed subarachnoid space entry.

Main Results:

Paresthesias were reported in 13.6% of patients (14/103).
All paresthesias were transient.
Cerebrospinal fluid was observed in the needle hub in 86.7% of cases following a paresthesia.

Conclusions:

The findings suggest most transient paresthesias during spinal needle placement result from contact with a spinal nerve root in the subarachnoid space.
When paresthesias occur, it is recommended to assess for CSF, rather than immediately withdrawing and redirecting the needle.