Just below the third lumbar spine a little to the right of the middle line, push the needle slightly upward and inward at an angle sufficient to meet the spinal membranes in the middle line. Pushing steadily upward and inward, you can feel it reach the resisting ligamentum subflava and finally puncture the membranes by the flow of spinal fluid from the needle. Hold your finger over the outlet until the syringe can be attached; then let enough fluid run into the syringe to make 2 c.c., making a mixture containing equal parts of stovaine solution and spinal fluid. The clear spinal fluid becomes milky on meeting the anesthetic solution. Now slowly inject the mixture, and when the syringe is emptied, withdraw the needle with a rapid movement and seal the puncture with collodion. It will require no further attention.
Have the patient lie down and prepare for the operation. In ten to fifteen minutes, anesthesia begins; the patient feels a pricking sensation in their feet and numbness in their legs. A pinch or pin prick will be felt but not painful. If pain becomes too severe during the operation, use chloroform or ether. If the anesthetic zone does not extend high enough, incline the body slightly with head downward. During the operation, the patient's face is likely to be congested and their head throb. Afterwards, there may be a severe headache for a little while and perhaps some nausea.
The site of puncture can be numbed with cocaine so that spinal injection is painless. If the needle engages against vertebrae, withdraw slightly and change direction as judgment dictates. The most common mistake is directing the needle too much upward; only very rarely will one fail to reach the spinal canal if landmarks are well defined.
Hollander protests against many surgeons turning away from spinal anesthesia, indicating its many advantages such as preventing post-operative paralysis of the bowel in abdominal work. He mentions 60 operations including appendix, stomach, pancreas, kidney, gallbladder and uterus operated under spinal anesthesia all of which promptly recovered. Jonnesco reports most favorable results with stovaine modified by strychnia; he does not hesitate to puncture the cord at the cervico-dorsal juncture.
<Callout type="important" title="Critical Step">Ensure you correctly identify and follow spinal landmarks to avoid injury.</Callout>
Under spinal anesthesia, operations on every part of the body can be performed.
Key Takeaways
- Correct needle placement is crucial for effective and safe spinal anesthesia.
- Post-operative complications such as bowel paralysis can be prevented with proper use of spinal anesthesia.
- Patient monitoring is essential during the procedure to ensure comfort and safety.
Practical Tips
- Use collodion to seal the puncture site after injection, reducing risk of infection.
- Prepare for potential side effects like headache or nausea post-procedure.
- Incline patient's body slightly with head down if anesthetic zone does not extend high enough.
Warnings & Risks
- Improper needle direction can lead to serious injury such as puncturing vertebrae.
- Failure to correctly identify spinal landmarks may result in ineffective anesthesia or complications.
Modern Application
While the techniques described here are foundational, modern anesthesiology has advanced significantly with safer drugs and more precise methods. However, understanding these historical practices provides critical insight into the evolution of medical care and can be invaluable in emergency situations where traditional equipment is unavailable.
Frequently Asked Questions
Q: What happens if the needle engages against vertebrae during spinal anesthesia?
If the needle engages against vertebrae, it should be withdrawn slightly and the direction changed as judgment dictates to avoid injury.
Q: How long does it take for spinal anesthesia to begin after injection?
Spinal anesthesia typically begins in ten to fifteen minutes after injection; patients will feel a pricking sensation in their feet followed by numbness in the legs.
Q: What is one of the main advantages of using spinal anesthesia according to Hollander?
According to Hollander, spinal anesthesia can prevent post-operative paralysis of the bowel in abdominal work.