Local anesthetic larger amount (6~16ml) water for injection

Local anesthetic cerebrospinal fluid, the level of anesthesia is uncertain, use sparingly

Local anesthetic GS (5%~10%)

Higher than T4

T5~T9

Below T10

The block is limited to the perineum and buttocks

blocking sequence

block plane

cycle

breathe

gastrointestinal tract

Genitourinary

Lower abdominal and pelvic surgery

Anal and perineal surgery

Lower limb surgery

labor analgesia

The operation time is 2~3 hours

Central nervous system diseases (especially spinal cord or spinal neuropathy)

systemic severe infection

Shock (absolute contraindication, sudden drop in blood pressure after spinal anesthesia, cardiac arrest), mental illness, children, etc. who cannot cooperate

Coronary artery disease, history of spinal trauma or deformity, insufficient circulatory reserve

For those with significantly increased intra-abdominal pressure (large amounts of ascites, huge tumors), once the intra-abdominal pressure drops suddenly, the circulation will be unstable

Headache

urinary retention

neurological complications

Only local anesthesia is performed. Spinal anesthesia is easy to spread and the plane is difficult to effectively control.

Spinal anesthesia is most commonly used

0.5%~0.75% bupivacaine 2ml, cerebrospinal fluid 1ml, heavy specific gravity solution, block to T10 dose: 10~15mg

The onset of effect is 4 to 8 minutes, so it is not advisable to adjust the level too quickly to avoid the level being too high.

Maintain for 130~230 minutes (2~4h)

Less toxic, highly safe, can produce sensory and motor block separation

0.5%~0.75% ropivacaine 2ml, cerebrospinal fluid 1ml, heavy specific gravity solution, block to T10 dose: 12~18mg

Maintain for 80~210 minutes (1.5~4h)

It can avoid supraspinal and interspinous ligaments, especially suitable for elderly patients with ligament calcification, obese patients with spinal deformity and unclear spinous process space.

Solution: compress the jugular vein, hold your breath, rotate the needle tip 180°, and aspirate with the syringe

Upper abdominal surgery, cesarean section: T4

Hip surgery, transurethral resection of the prostate: T10

Foot and Ankle Surgery: L2

The spine has 4 physiological curvatures

Puncture and inject medicine at L2~3, turn to supine position, medicine goes to the head side, anesthesia level is high

Puncture and inject medicine at L3~4 or L4~5. Turn to supine position. The medicine will go to the side of the feet. The level of anesthesia is low.

For abdominal surgery, choose L2~3; lower limbs and perineum and anus should not exceed L3~4

Adjust your body position 5 to 10 minutes after injecting the medicine, and move the heavier medicine lower than the heavy medicine.

The faster the speed, the wider the block plane. Generally, 1ml is injected every 5 seconds.

The inclined plane moves toward the head, and the anesthesia level is high.

The plane is higher than T4. 15 to 30 minutes after injection, the heart rate will be slow. In severe cases, nausea and vomiting will occur due to insufficient blood supply to the brain, and the face will look pale and restless.

Can be quickly infused with 200~300ml; if ineffective, iv ephedrine 5~10mg can be repeated if necessary

If the heart rate is slow, iv atropine 0.25~0.3mg

Intercostal muscle paralysis, rapid oxygen or assisted breathing

"Total spinal anesthesia" causes respiratory arrest, sudden drop in blood pressure, or even cardiac arrest. Immediate tracheal intubation, mechanical ventilation, and chest compressions

Deal with it according to the reason