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Related Concept Videos

Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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 Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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...
Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
Anatomical Positions01:11

Anatomical Positions

In anatomy, several standard anatomical positions are used as references for describing the position and orientation of different body parts. These positions help provide a common frame of reference when discussing anatomical structures. The anatomical position is the standard reference point for describing the body's position and orientation. In this position:
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Muscles of the Vertebral Column01:27

Muscles of the Vertebral Column

The back muscles that lie deep into the thoracolumbar fascia are called intrinsic or true back muscles. These muscles are divided into four layers: superficial, intermediate, deep, and deepest layers.
Superficial Layer:
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General Anesthesia: Overview01:24

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...

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Related Experiment Video

Updated: May 19, 2026

Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
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Straight versus flex back: Does it matter in spinal anaesthesia?

Binay Kumar Biswas1, Bikash Agarwal, Balakrishna Bhattarai

  • 1Department of Anesthesiology, Pain and Perioperative Medicine, ESI Post Graduate Institute of Medical Science and Research, Manicktala, Kolkata, India.

Indian Journal of Anaesthesia
|August 28, 2012
PubMed
Summary

Subarachnoid block success rates were comparable whether patients kept their back straight or flexed. Most patients preferred the straight back position during the procedure.

Keywords:
Anaesthesia – neuraxialattitudepositionspinal

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Area of Science:

  • Anesthesiology
  • Neurosurgery

Background:

  • Performing subarachnoid blocks can be challenging when patients cannot achieve adequate back flexion.
  • Patient positioning is crucial for procedural success in regional anesthesia.

Purpose of the Study:

  • To evaluate procedural success and patient preference for subarachnoid blocks with straight versus flexed back positions.
  • To compare needle placement outcomes in different patient postures for subarachnoid anesthesia.

Main Methods:

  • 160 adult patients without spinal deformities underwent subarachnoid blocks in lateral or seated positions, with backs straight or flexed.
  • Patients were divided into four groups: Lateral-Straight (LS), Lateral-Flexed (LF), Seated-Straight (SS), and Seated-Flexed (SF).
  • Key outcomes included correct needle placement, number of attempts, needle redirections, and patient-preferred posture.

Main Results:

  • Overall success rates were 95% (straight back) and 100% (flexed back), with no significant difference (P=0.81).
  • The Lateral-Flexed group showed significantly more first-attempt successes (40 patients) than the Lateral-Straight group (32 patients; P=0.03).
  • Fewer cephalad needle redirections occurred in the Seated-Flexed group (21 patients) compared to the Seated-Straight group (34 patients; P=0.003).

Conclusions:

  • Patient preference leaned towards the straight back position (69.7-88%) during subarachnoid block procedures.
  • The study found comparable overall success rates for spinal needle placement regardless of whether the back was straight or flexed.
  • While patient preference favors a straight back, procedural success rates do not significantly differ between straight and flexed postures.