Anestesi Spinal :ILA and Saddle Block

LUSI JELITA SARI

FK TRISAKTI

03011171

ANATOMY OF SPINAL CORD

33 Vertebrae◦7 Cervical◦12 Thoracic◦5 Lumbar◦5 Sacral◦4 Coccygeal

ANATOMY OF SPINAL CORD• Spinal Cord

– Adult• Begins: Foramen Magnum• Ends: L1

– Newborn• Begins: Foramen Magnum• Ends: L3

– Terminal End: Conus Medullaris– Filum Terminale: Anchors in sacral region– Cauda Equina: Nerve group of lower dural sac

Saggital Sections

Spinal MeningesDura Mater

◦Outer most layer◦ Fibrous

Arachnoid◦Middle layer◦Non-vascular

Pia◦ Inner most layer◦Highly vascular

Sub Arachnoid Space◦ Lies between the arachnoid

and pia

Physiology Of Childbirth

Stage I

Stage II

Stage III

Stage IV

Sources of Pain During Labour

DEFINITION

Indication of Spinal Anesthesia

• Lower extremity surgery

• Pelvic surgery

• Obstretrical surgery

• Rectum and perineum

• Urology surgery

• Lower abdominal surgery

Contraindications of Spinal Anasthesia

Absolute• Patient refused • Infection at the injection site• Coagulopathy• Severe hypovolemia• Increased intracranial pressure• Inexperience / unaccompained

consultanst• Severe hypotention

relative

• Sepsis• Uncooperative pasient• Neurological disorder• Severe spinal deformity

Complications

• Hypotention

• Bradycardia

• Vomiting, nausea

• High spinal

– Spinal head ache• More common in women ages 13-40• Larger needle size increase severity• Onset typically occurs first or second day post-op• Treatment:

– Bed rest– Fluids– Caffeine– Blood patch

Spinal Technique

• Preload with 500- 1000ml crystalloid• Premedicate Preparation & Monitoring

◦EKG◦NBP◦Pulse Oximeter

Patient Positioning◦ Lateral decubitous◦Sitting◦Prone (hypobaric technique)

• Mark the location of injection• sterilize

Drugs in Spinal Anesthesia

• hyperbaric

-Lidokaine 5% in dextrose 7.5%,

dose :20-50mg(1-2ml).

-Bupivakaine 0.5% in dextrose 8.25% ,

dose : 5-15mg(1-3ml).• Isobaric

-Bupivakaine 0.5% in water, dose : 5-20mg.

ILA (Intrathecal Labour Analgesia)

• Requirement

- Patient demand

- Informed consent

Drugs In ILA

• Fentanil

• Klonidin

• Buvipacain o,5% heavy

Indication of ILA

mother

• Labor pain• Long first stage of labor• Anxietas• Patient demand• Pregnancy with

abnormalities of the cardiovascular system

baby

• premature

Contraindications of ILA

• Patient refused

• Local infection

• Bleeding disorder

• Allergy

• Post SC

Saddle Block

• Indication of saddle block

- Perineum

- Buttocks

- Inner thighs

Saddle Block Technique

THANK YOU