Sher Mohammad and others look at different approaches to performing spinal anaesthesia
The tale of spinal anaesthesia
According to history, Hippocrates (470-400BC) discovered for the first time “water of the brain”; Valsalva (1692) mentioned watery fluid around canine spinal cord; and Magendie (1825) described the circulation of the fluid around brain and spinal cord and named it CSF.
In 1855, Friedrich Gaedcke was the first person to chemically isolate cocaine from a coca plant and called this alkaloid as erythroxyline, and James Leonard injected cocaine between the spinous processes of lumbar vertebrae, first in a dog and then in a man. Heinrich Quickie (1890) was the first man to perform lumbar dural puncture in Kiel, Germany. Controversy developed as to who was the first to conduct spinal anaesthetic, however, August Bier, a German surgeon is considered to be the father of spinal anaesthesia, probably working in collaboration with Quinkie. On August 16, 1898, Bier performed the first intrathecal anaesthetic on his assistant. He also reported a postdural puncture headache, which lasted for nine days. The technique of spinal anaesthesia was introduced across the Atlantic by Rudolph Matas (1899).
Fidel Pages (1921), a Spanish army surgeon, developed the technique of lumbar epidural anaesthesia and Doglioti described the loss of resistance technique. Ralph Huber (1940) a Seattle dentist was the inventor of the Tuohy needle, but it is known by the name of Edward Tuohy, an anaesthetist in the US who popularised it in 1945.
Lemmon (1940) at the Mayo Clinic, used the first continuous spinal technique and saddle anaesthesia was described by Adriani and Roman-Vega in 1946. Lastly, spinal morphine was administered by Wang in 1979. Currently, ultrasound and other imaging are used as adjuncts in difficult cases such as a patient with morbid obesity.
Practical steps when doing spinal anaesthesia
Individual anaesthetists have their own ways of performing central neuraxial anaesthesia. We have looked at different approaches and collected evidence from the literature and reached a conclusion as to how to describe it.
The following is an acronymic approach of doing spinal anaesthesia, the readers do not need to agree with our description. Remember the acronym ”SPINAL”. The same is applicable whilst doing epidural technique.
S See the patient in the ward
Spot any problem with SAB (see patient’s notes)
Side effects and benefits discussed
Steps of procedure explained
Sterile trolley available
Spinal pack checked
Standard monitoring/resuscitation equipment checked
Stop before you block approach
P Patient identified in anaesthetic room
Peripheral IV cannulation (large bore)
Practitioner scrubbed
Prepare LA for S/C and LA for SAB
Position upright/lateral
Pour antiseptic spray on the back and use clean drapes
Palpate for L2/3 or L3/4 interspaces
I Inject lignocaine S/C
Introducer pushed in
N Neuraxial needle into introducer
Needle in midline→