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Neuraxial Blocks: Spinal and Epidural Anesthesia

  • Chapter
Regional Nerve Blocks in Anesthesia and Pain Therapy

Abstract

Central neuraxial techniques are among the most reliable regional anesthesia techniques at the disposal of the anesthesiologist. Although they are relatively simple to perform, a thorough knowledge of underlying neuraxial anatomy and factors determining the spread and duration of anesthesia is critical to their success. Also, an understanding of the physiological effects and potential complications of these neuraxial techniques is paramount to ensure safe application of these methods.

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References

  1. Chakraverty R, Pynsent P, Isaacs K. Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines? J Anat. 2007;210(2):232–6.

    PubMed Central  PubMed  Google Scholar 

  2. Tamakawa S. Comparing the confidence of the 7th cervical spinous process, the inferior angle of the scapula, and Tuffier’s line. Reg Anesth Pain Med. 1999;24(6):585–6.

    CAS  PubMed  Google Scholar 

  3. Kim J-T, Bahk J-H, Sung J. Influence of age and sex on the position of the conus medullaris and Tuffier’s line in adults. Anesthesiology. 2003;99(6):1359–63.

    PubMed  Google Scholar 

  4. Margarido CB, Mikhael R, Arzola C, Balki M, Carvalho JCA. The intercristal line determined by palpation is not a reliable anatomical landmark for neuraxial anesthesia. Can J Anaesth. 2011;58(3):262–6.

    PubMed  Google Scholar 

  5. Snider KT, Kribs JW, Snider EJ, Degenhardt BF, Bukowski A, Johnson JC. Reliability of Tuffier’s line as an anatomic landmark. Spine (Phila Pa 1976). 2008;33(6):E161–5.

    Google Scholar 

  6. Furness G, Reilly MP, Kuchi S. An evaluation of ultrasound imaging for identification of lumbar intervertebral level. Anaesthesia. 2002;57(3):277–80.

    CAS  PubMed  Google Scholar 

  7. Pysyk CL, Persaud D, Bryson GL, Lui A. Ultrasound assessment of the vertebral level of the palpated intercristal (Tuffier’s) line. Can J Anaesth. 2010;57(1):46–9.

    PubMed  Google Scholar 

  8. Panjabi MM, Duranceau J, Goel V, Oxland T, Takata K. Cervical human vertebrae. Quantitative three-dimensional anatomy of the middle and lower regions. Spine (Phila Pa 1976). 1991;16(8):861–9.

    CAS  Google Scholar 

  9. Panjabi MM, Takata K, Goel V, Federico D, Oxland T, Duranceau J, et al. Thoracic human vertebrae. Quantitative three-dimensional anatomy. Spine (Phila Pa 1976). 1991;16(8):888–901.

    CAS  Google Scholar 

  10. Panjabi MM, Goel V, Oxland T, Takata K, Duranceau J, Krag M, et al. Human lumbar vertebrae. Quantitative three-dimensional anatomy. Spine (Phila Pa 1976). 1992;17(3):299–306.

    CAS  Google Scholar 

  11. Barker AE. A report on clinical experiences with spinal analgesia in 100 cases, and some reflections on the procedure. Br Med J. 1907;1(2412):665–74.

    CAS  PubMed Central  PubMed  Google Scholar 

  12. Cheng PA. The anatomical and clinical aspects of epidural anesthesia. II. Anesth Analg. 1963;42(4):407–15.

    CAS  PubMed  Google Scholar 

  13. Cheng PA. The anatomical and clinical aspects of epidural anesthesia. I. Anesth Analg. 1963;42(3):398–406.

    CAS  PubMed  Google Scholar 

  14. Hughes G, Ugokwe K, Benzel EC. A review of spinal arachnoid cysts. Cleve Clin J Med. 2008;75(4):311–5.

    PubMed  Google Scholar 

  15. Stace JD, Gaylard DG. Failed spinal anaesthesia. Anaesthesia. 1996;51(9):892–3.

    CAS  PubMed  Google Scholar 

  16. Bromage PR. Neurological complications of subarachnoid and epidural anaesthesia. Acta Anaesthesiol Scand. 1997;41(4):439–44.

    CAS  PubMed  Google Scholar 

  17. Lirk P, Kolbitsch C, Putz G, Colvin J, Colvin HP, Lorenz I, et al. Cervical and high thoracic ligamentum flavum frequently fails to fuse in the midline. Anesthesiology. 2003;99(6):1387–90.

    PubMed  Google Scholar 

  18. Hogan QH. Lumbar epidural anatomy. A new look by cryomicrotome section. Anesthesiology. 1991;75(5):767–75.

    CAS  PubMed  Google Scholar 

  19. Hogan Q. Distribution of solution in the epidural space: examination by cryomicrotome section. Reg Anesth Pain Med. 2002;27(2):150–6.

    PubMed  Google Scholar 

  20. Reina MA, Franco CD, López A, Dé Andrés JA, van Zundert A. Clinical implications of epidural fat in the spinal canal. A scanning electron microscopic study. Acta Anaesthesiol Belg. 2009;60(1):7–17.

    CAS  PubMed  Google Scholar 

  21. Bernards CM, Shen DD, Sterling ES, Adkins JE, Risler L, Phillips B, et al. Epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidural opioids (part 1): differences among opioids. Anesthesiology. 2003;99(2):455–65.

    CAS  PubMed  Google Scholar 

  22. Igarashi T, Hirabayashi Y, Shimizu R, Saitoh K, Fukuda H, Mitsuhata H. The lumbar extradural structure changes with increasing age. Br J Anaesth. 1997;78(2):149–52.

    CAS  PubMed  Google Scholar 

  23. Harrison GR, Clowes NW. The depth of the lumbar epidural space from the skin. Anaesthesia. 1985;40(7):685–7.

    CAS  PubMed  Google Scholar 

  24. Ravi KK, Kaul TK, Kathuria S, Gupta S, Khurana S. Distance from skin to epidural space: correlation with body mass index (BMI). J Anaesthesiol Clin Pharmacol. 2011;27(1):39–42.

    PubMed Central  PubMed  Google Scholar 

  25. Balki M, Lee Y, Halpern S, Carvalho JCA. Ultrasound imaging of the lumbar spine in the transverse plane: the correlation between estimated and actual depth to the epidural space in obese parturients. Anesth Analg. 2009;108(6):1876–81.

    PubMed  Google Scholar 

  26. Fink BR, Cairns AM. Differential slowing and block of conduction by lidocaine in individual afferent myelinated and unmyelinated axons. Anesthesiology. 1984;60(2):111–20.

    CAS  PubMed  Google Scholar 

  27. Jaffe RA, Rowe MA. Differential nerve block. Direct measurements on individual myelinated and unmyelinated dorsal root axons. Anesthesiology. 1996;84(6):1455–64.

    CAS  PubMed  Google Scholar 

  28. Liu S, Kopacz DJ, Carpenter RL. Quantitative assessment of differential sensory nerve block after lidocaine spinal anesthesia. Anesthesiology. 1995;82(1):60–3.

    CAS  PubMed  Google Scholar 

  29. Neal JM. Hypotension and bradycardia during spinal anesthesia: significance, prevention, and treatment. Tech Reg Anesth Pain Manag. 2000;4(4):148–54.

    Google Scholar 

  30. Crystal GJ, Salem MR. The Bainbridge and the “reverse” Bainbridge reflexes: history, physiology, and clinical relevance. Anesth Analg. 2012;114(3):520–32.

    CAS  PubMed  Google Scholar 

  31. Campagna JA, Carter C. Clinical relevance of the Bezold-Jarisch reflex. Anesthesiology. 2003;98(5):1250–60.

    PubMed  Google Scholar 

  32. Otton PE, Wilson EJ. The cardiocirculatory effects of upper thoracic epidural analgesia. Can Anaesth Soc J. 1966;13(6):541–9.

    CAS  PubMed  Google Scholar 

  33. Subramani K, Paul A. Laryngospasm during subarachnoid block. Br J Anaesth. 2005;94(5):668–70.

    CAS  PubMed  Google Scholar 

  34. Pollard JB. Cardiac arrest during spinal anesthesia: common mechanisms and strategies for prevention. Anesth Analg. 2001;92(1):252–6.

    CAS  PubMed  Google Scholar 

  35. Steinbrook RA, Concepcion M. Respiratory effects of spinal anesthesia: resting ventilation and single-breath CO2 response. Anesth Analg. 1991;72(2):182–6.

    CAS  PubMed  Google Scholar 

  36. Groeben H. Epidural anesthesia and pulmonary function. J Anesth. 2006;20(4):290–9.

    PubMed  Google Scholar 

  37. Leslie JB, Viscusi ER, Pergolizzi JV, Panchal SJ. Anesthetic routines: the anesthesiologist’s role in GI recovery and postoperative ileus. Adv Prev Med. 2011;2011:976904.

    PubMed Central  PubMed  Google Scholar 

  38. Shi W-Z, Miao Y-L, Yakoob MY, Cao J-B, Zhang H, Jiang Y-G, et al. Recovery of gastrointestinal function with thoracic epidural vs. systemic analgesia following gastrointestinal surgery. Acta Anaesthesiol Scand. 2014;58(8):923–32.

    PubMed  Google Scholar 

  39. Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992;76(6):906–16.

    CAS  PubMed  Google Scholar 

  40. Sessler DI, Ponte J. Shivering during epidural anesthesia. Anesthesiology. 1990;72(5):816–21.

    CAS  PubMed  Google Scholar 

  41. Shehabi Y, Gatt S, Buckman T, Isert P. Effect of adrenaline, fentanyl and warming of injectate on shivering following extradural analgesia in labour. Anaesth Intensive Care. 1990;18(1):31–7.

    CAS  PubMed  Google Scholar 

  42. Hjortsø NC, Neumann P, Frøsig F, Andersen T, Lindhard A, Rogon E, et al. A controlled study on the effect of epidural analgesia with local anaesthetics and morphine on morbidity after abdominal surgery. Acta Anaesthesiol Scand. 1985;29(8):790–6.

    PubMed  Google Scholar 

  43. Hosoda R, Hattori M, Shimada Y. Favorable effects of epidural analgesia on hemodynamics, oxygenation and metabolic variables in the immediate post-anesthetic period. Acta Anaesthesiol Scand. 1993;37(5):469–74.

    CAS  PubMed  Google Scholar 

  44. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology. 1995;82(6):1474–506.

    CAS  PubMed  Google Scholar 

  45. Ballantyne J. Does regional anesthesia improve outcome after surgery? Curr Opin Anaesthesiol. 1999;12(5):545–9.

    CAS  PubMed  Google Scholar 

  46. Breivik H, Bang U, Jalonen J, Vigfússon G, Alahuhta S, Lagerkranser M. Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand. 2010;54(1):16–41.

    CAS  PubMed  Google Scholar 

  47. Kettner SC, Willschke H, Marhofer P. Does regional anaesthesia really improve outcome? Br J Anaesth. 2011;107 Suppl 1:i90–5.

    CAS  PubMed  Google Scholar 

  48. Memtsoudis SG, Sun X, Chiu Y-L, Stundner O, Liu SS, Banerjee S, et al. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013;118(5):1046–58.

    PubMed Central  PubMed  Google Scholar 

  49. Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK. Executive summary: regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med. 2010;35(1):102–5.

    PubMed  Google Scholar 

  50. Hurst E. Adhesive arachnoiditis and vascular blockage caused by detergents and other chemical irritants: an experimental study. J Pathol Bacteriol. 1955;70(1):167–78.

    CAS  PubMed  Google Scholar 

  51. Cook TM, Counsell D, Wildsmith JAW. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 2009;102(2):179–90.

    CAS  PubMed  Google Scholar 

  52. Lambert DH, Hurley RJ, Hertwig L, Datta S. Role of needle gauge and tip configuration in the production of lumbar puncture headache. Reg Anesth. 1997;22(1):66–72.

    CAS  PubMed  Google Scholar 

  53. Parker RK, White PF. A microscopic analysis of cut-bevel versus pencil-point spinal needles. Anesth Analg. 1997;85(5):1101–4.

    CAS  PubMed  Google Scholar 

  54. Richman JM, Joe EM, Cohen SR, Rowlingson AJ, Michaels RK, Jeffries MA, et al. Bevel direction and postdural puncture headache: a meta-analysis. Neurologist. 2006;12(4):224–8.

    PubMed  Google Scholar 

  55. Obasuyi BI, Fyneface-Ogan S, Mato CN. A comparison of the haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for caesarean section. Int J Obstet Anesth. 2013;22(2):124–8.

    CAS  PubMed  Google Scholar 

  56. Kinsella SM, Lohmann G. Supine hypotensive syndrome. Obstet Gynecol. 1994;83(5 Pt 1):774–88.

    CAS  PubMed  Google Scholar 

  57. Edgcombe H, Carter K, Yarrow S. Anaesthesia in the prone position. Br J Anaesth. 2008;100(2):165–83.

    CAS  PubMed  Google Scholar 

  58. Rabinowitz A, Bourdet B, Minville V, Chassery C, Pianezza A, Colombani A, et al. The paramedian technique: a superior initial approach to continuous spinal anesthesia in the elderly. Anesth Analg. 2007;105(6):1855–7.

    CAS  PubMed  Google Scholar 

  59. Enk D, Prien T, Van Aken H, Mertes N, Meyer J, Brüssel T. Success rate of unilateral spinal anesthesia is dependent on injection flow. Reg Anesth Pain Med. 2001;26(5):420–7.

    CAS  PubMed  Google Scholar 

  60. Casati A, Fanelli G. Unilateral spinal anesthesia. State of the art. Minerva Anestesiol. 2001;67(12):855–62.

    CAS  PubMed  Google Scholar 

  61. Kuusniemi KS, Pihlajamäki KK, Pitkänen MT, Korkeila JE. A low-dose hypobaric bupivacaine spinal anesthesia for knee arthroscopies. Reg Anesth. 1997;22(6):534–8.

    CAS  PubMed  Google Scholar 

  62. Denny NM, Selander DE. Continuous spinal anaesthesia. Br J Anaesth. 1998;81(4):590–7.

    CAS  PubMed  Google Scholar 

  63. Gosch UW, Hueppe M, Hallschmid M, Born J, Schmucker P, Meier T. Post-dural puncture headache in young adults: comparison of two small-gauge spinal catheters with different needle design. Br J Anaesth. 2005;94(5):657–61.

    CAS  PubMed  Google Scholar 

  64. Horlocker TT, McGregor DG, Matsushige DK, Chantigian RC, Schroeder DR, Besse JA. Neurologic complications of 603 consecutive continuous spinal anesthetics using macrocatheter and microcatheter techniques. Perioperative Outcomes Group. Anesth Analg. 1997;84(5):1063–70.

    CAS  PubMed  Google Scholar 

  65. Faust A, Fournier R, Van Gessel E, Weber A, Hoffmeyer P, Gamulin Z. Isobaric versus hypobaric spinal bupivacaine for total hip arthroplasty in the lateral position. Anesth Analg. 2003;97(2):589–94, table of contents.

    PubMed  Google Scholar 

  66. Dyamanna DN, Bs SK, Zacharia BT. Unexpected bradycardia and cardiac arrest under spinal anesthesia: case reports and review of literature. Middle East J Anesthesiol. 2013;22(1):121–5.

    PubMed  Google Scholar 

  67. Russell IF. A comparison of cold, pinprick and touch for assessing the level of spinal block at caesarean section. Int J Obstet Anesth. 2004;13(3):146–52.

    CAS  PubMed  Google Scholar 

  68. Ousley R, Egan C, Dowling K, Cyna AM. Assessment of block height for satisfactory spinal anaesthesia for caesarean section. Anaesthesia. 2012;67(12):1356–63.

    CAS  PubMed  Google Scholar 

  69. Zarzur E. Anatomic studies of the human ligamentum flavum. Anesth Analg. 1984;63(5):499–502.

    CAS  PubMed  Google Scholar 

  70. Saberski LR, Kondamuri S, Osinubi OY. Identification of the epidural space: is loss of resistance to air a safe technique? A review of the complications related to the use of air. Reg Anesth. 1997;22(1):3–15.

    CAS  PubMed  Google Scholar 

  71. Todorov L, VadeBoncouer T. Etiology and use of the “hanging drop” technique: a review. Pain Res Treat. 2014;2014:Article ID 146750, 10 p.

    Google Scholar 

  72. Guay J. The epidural test dose: a review. Anesth Analg. 2006;102(3):921–9.

    PubMed  Google Scholar 

  73. Walker DS, Brock-Utne JG. A comparison of simple tests to distinguish cerebrospinal fluid from saline. Can J Anaesth. 1997;44(5 Pt 1):494–7.

    CAS  PubMed  Google Scholar 

  74. Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and management. Br J Anaesth. 2012;109(2):144–54.

    CAS  PubMed  Google Scholar 

  75. Arendt K, Segal S. Why epidurals do not always work. Rev Obstet Gynecol. 2008;1(2):49–55.

    PubMed Central  PubMed  Google Scholar 

  76. Camorcia M, Capogna G. Sensory assessment of epidural block for Caesarean section: a systematic comparison of pinprick, cold and touch sensation. Eur J Anaesthesiol. 2006;23(7):611–7.

    CAS  PubMed  Google Scholar 

  77. Graham AC, McClure JH. Quantitative assessment of motor block in labouring women receiving epidural analgesia. Anaesthesia. 2001;56(5):470–6.

    CAS  PubMed  Google Scholar 

  78. Van Zundert A, Vaes L, Van der Aa P, Van der Donck A, Meeuwis H. Motor blockade during epidural anesthesia. Anesth Analg. 1986;65(4):333–6.

    PubMed  Google Scholar 

  79. Ellinas EH, Eastwood DC, Patel SN, Maitra-D’Cruze AM, Ebert TJ. The effect of obesity on neuraxial technique difficulty in pregnant patients: a prospective, observational study. Anesth Analg. 2009;109(4):1225–31.

    PubMed  Google Scholar 

  80. Hood DD, Dewan DM. Anesthetic and obstetric outcome in morbidly obese parturients. Anesthesiology. 1993;79(6):1210–8.

    CAS  PubMed  Google Scholar 

  81. Grau T, Leipold RW, Conradi R, Martin E, Motsch J. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 2002;14(3):169–75.

    PubMed  Google Scholar 

  82. White AA, Panjabi MM. The clinical biomechanics of scoliosis. Clin Orthop Relat Res. 1976;118:100–12.

    PubMed  Google Scholar 

  83. Boon JM, Prinsloo E, Raath RP. A paramedian approach for epidural block: an anatomic and radiologic description. Reg Anesth Pain Med. 2003;28(3):221–7.

    PubMed  Google Scholar 

  84. Huang J. Paramedian approach for neuroaxial anesthesia in parturients with scoliosis. Anesth Analg. 2010;111(3):821–2; author reply 822.

    PubMed  Google Scholar 

  85. Berkowitz S, Gold MI. Spinal anesthesia for surgery in patients with previous lumbar laminectomy. Anesth Analg. 1980;59(11):881–2.

    CAS  PubMed  Google Scholar 

  86. Kim SH, Jeon D-H, Chang CH, Lee S-J, Shin Y-S. Spinal anesthesia with isobaric tetracaine in patients with previous lumbar spinal surgery. Yonsei Med J. 2009;50(2):252–6.

    PubMed Central  PubMed  Google Scholar 

  87. Sharrock NE, Urquhart B, Mineo R. Extradural anaesthesia in patients with previous lumbar spine surgery. Br J Anaesth. 1990;65(2):237–9.

    CAS  PubMed  Google Scholar 

  88. Brodsky AE. Post-laminectomy and post-fusion stenosis of the lumbar spine. Clin Orthop Relat Res. 1976;115:130–9.

    PubMed  Google Scholar 

  89. LaRocca H, Macnab I. The laminectomy membrane. Studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Joint Surg Br. 1974;56B(3):545–50.

    CAS  PubMed  Google Scholar 

  90. Yamauchi M, Honma E, Mimura M, Yamamoto H, Takahashi E, Namiki A. Identification of the lumbar intervertebral level using ultrasound imaging in a post-laminectomy patient. J Anesth. 2006;20(3):231–3.

    PubMed  Google Scholar 

  91. Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg. 1985;64(7):715–30.

    CAS  PubMed  Google Scholar 

  92. Hocking G, Wildsmith JAW. Intrathecal drug spread. Br J Anaesth. 2004;93(4):568–78.

    CAS  PubMed  Google Scholar 

  93. Stienstra R, van Poorten JF. Plain or hyperbaric bupivacaine for spinal anesthesia. Anesth Analg. 1987;66(2):171–6.

    CAS  PubMed  Google Scholar 

  94. Van Zundert AA, Grouls RJ, Korsten HH, Lambert DH. Spinal anesthesia. Volume or concentration–what matters? Reg Anesth. 1996;21(2):112–8.

    PubMed  Google Scholar 

  95. Wildsmith JA, McClure JH, Brown DT, Scott DB. Effects of posture on the spread of isobaric and hyperbaric amethocaine. Br J Anaesth. 1981;53(3):273–8.

    CAS  PubMed  Google Scholar 

  96. Kito K, Kato H, Shibata M, Adachi T, Nakao S, Mori K. The effect of varied doses of epinephrine on duration of lidocaine spinal anesthesia in the thoracic and lumbosacral dermatomes. Anesth Analg. 1998;86(5):1018–22.

    CAS  PubMed  Google Scholar 

  97. Singh H, Yang J, Thornton K, Giesecke AH. Intrathecal fentanyl prolongs sensory bupivacaine spinal block. Can J Anaesth. 1995;42(11):987–91.

    CAS  PubMed  Google Scholar 

  98. Hirabayashi Y, Shimizu R, Saitoh K, Fukuda H, Furuse M. Anatomical configuration of the spinal column in the supine position. I. A study using magnetic resonance imaging. Br J Anaesth. 1995;75(1):3–5.

    CAS  PubMed  Google Scholar 

  99. Tuominen M, Taivainen T, Rosenberg PH. Spread of spinal anaesthesia with plain 0.5 % bupivacaine: influence of the vertebral interspace used for injection. Br J Anaesth. 1989;62(4):358–61.

    CAS  PubMed  Google Scholar 

  100. Sakura S, Sumi M, Morimoto N, Yamamori Y, Saito Y. Spinal anesthesia with tetracaine in 0.75 % glucose: influence of the vertebral interspace used for injection. Reg Anesth Pain Med. 1998;23(2):170–5.

    CAS  PubMed  Google Scholar 

  101. Urmey WF, Stanton J, Bassin P, Sharrock NE. The direction of the Whitacre needle aperture affects the extent and duration of isobaric spinal anesthesia. Anesth Analg. 1997;84(2):337–41.

    CAS  PubMed  Google Scholar 

  102. Stienstra R, van Poorten F, Kroon JW. Needle direction affects the sensory level of spinal anesthesia. Anesth Analg. 1989;68(4):497–500.

    CAS  PubMed  Google Scholar 

  103. Janik R, Dick W, Stanton-Hicks MD. Influence of barbotage on block characteristics during spinal anesthesia with hyperbaric tetracaine and bupivacaine. Reg Anesth. 1989;14(1):26–30.

    CAS  PubMed  Google Scholar 

  104. Van Bogaert LJ. Lumbar lordosis and the spread of subarachnoid hyperbaric 0.5 % bupivacaine at cesarean section. Int J Gynaecol Obstet. 2000;71(1):65–6.

    PubMed  Google Scholar 

  105. Roofthooft E, Van de Velde M. Low-dose spinal anaesthesia for Caesarean section to prevent spinal-induced hypotension. Curr Opin Anaesthesiol. 2008;21(3):259–62.

    PubMed  Google Scholar 

  106. Cohen EN. Distribution of local anesthetic agents in the neuraxis of the dog. Anesthesiology. 1968;29(5):1002–5.

    CAS  PubMed  Google Scholar 

  107. Burm AG, van Kleef JW, Gladines MP, Spierdijk J, Breimer DD. Plasma concentrations of lidocaine and bupivacaine after subarachnoid administration. Anesthesiology. 1983;59(3):191–5.

    CAS  PubMed  Google Scholar 

  108. Greene NM. Uptake and elimination of local anesthetics during spinal anesthesia. Anesth Analg. 1983;62(11):1013–24.

    CAS  PubMed  Google Scholar 

  109. Burm AG, Van Kleef JW, Vermeulen NP, Olthof G, Breimer DD, Spierdijk J. Pharmacokinetics of lidocaine and bupivacaine following subarachnoid administration in surgical patients: simultaneous investigation of absorption and disposition kinetics using stable isotopes. Anesthesiology. 1988;69(4):584–92.

    CAS  PubMed  Google Scholar 

  110. Kooger Infante NE, Van Gessel E, Forster A, Gamulin Z. Extent of hyperbaric spinal anesthesia influences the duration of spinal block. Anesthesiology. 2000;92(5):1319–23.

    CAS  PubMed  Google Scholar 

  111. Moore JM, Liu SS, Pollock JE, Neal JM, Knab JH. The effect of epinephrine on small-dose hyperbaric bupivacaine spinal anesthesia: clinical implications for ambulatory surgery. Anesth Analg. 1998;86(5):973–7.

    CAS  PubMed  Google Scholar 

  112. Rathmell JP, Lair TR, Nauman B. The role of intrathecal drugs in the treatment of acute pain. Anesth Analg. 2005;101(5 Suppl):S30–43.

    PubMed  Google Scholar 

  113. Axelrod EH, Alexander GD, Brown M, Schork MA. Procaine spinal anesthesia: a pilot study of the incidence of transient neurologic symptoms. J Clin Anesth. 1998;10(5):404–9.

    CAS  PubMed  Google Scholar 

  114. Le Truong HH, Girard M, Drolet P, Grenier Y, Boucher C, Bergeron L. Spinal anesthesia: a comparison of procaine and lidocaine. Can J Anaesth. 2001;48(5):470–3.

    PubMed  Google Scholar 

  115. Casati A, Fanelli G, Danelli G, Berti M, Ghisi D, Brivio M, et al. Spinal anesthesia with lidocaine or preservative-free 2-chloroprocaine for outpatient knee arthroscopy: a prospective, randomized, double-blind comparison. Anesth Analg. 2007;104(4):959–64.

    CAS  PubMed  Google Scholar 

  116. Black AS, Newcombe GN, Plummer JL, McLeod DH, Martin DK. Spinal anaesthesia for ambulatory arthroscopic surgery of the knee: a comparison of low-dose prilocaine and fentanyl with bupivacaine and fentanyl. Br J Anaesth. 2011;106(2):183–8.

    CAS  PubMed  Google Scholar 

  117. Gebhardt V, Herold A, Weiss C, Samakas A, Schmittner MD. Dosage finding for low-dose spinal anaesthesia using hyperbaric prilocaine in patients undergoing perianal outpatient surgery. Acta Anaesthesiol Scand. 2013;57(2):249–56.

    CAS  PubMed  Google Scholar 

  118. Zaric D, Pace NL. Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics. Cochrane Database Syst Rev. 2009;2:CD003006.

    Google Scholar 

  119. Nair GS, Abrishami A, Lermitte J, Chung F. Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy. Br J Anaesth. 2009;102(3):307–15.

    CAS  PubMed  Google Scholar 

  120. Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg. 2002;94(1):188–93, table of contents.

    CAS  PubMed  Google Scholar 

  121. McDonald SB, Liu SS, Kopacz DJ, Stephenson CA. Hyperbaric spinal ropivacaine: a comparison to bupivacaine in volunteers. Anesthesiology. 1999;90(4):971–7.

    CAS  PubMed  Google Scholar 

  122. Gehling M, Tryba M. Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia. 2009;64(6):643–51.

    CAS  PubMed  Google Scholar 

  123. Raffaeli W, Marconi G, Fanelli G, Taddei S, Borghi GB, Casati A. Opioid-related side-effects after intrathecal morphine: a prospective, randomized, double-blind dose-response study. Eur J Anaesthesiol. 2006;23(7):605–10.

    CAS  PubMed  Google Scholar 

  124. Sultan P, Gutierrez MC, Carvalho B. Neuraxial morphine and respiratory depression: finding the right balance. Drugs. 2011;71(14):1807–19.

    CAS  PubMed  Google Scholar 

  125. Motiani P, Chaudhary S, Bahl N, Sethi AK. Intrathecal sufentanil versus fentanyl for lower limb surgeries – a randomized controlled trial. J Anaesthesiol Clin Pharmacol. 2011;27(1):67–73.

    CAS  PubMed Central  PubMed  Google Scholar 

  126. Nelson KE, Rauch T, Terebuh V, D’Angelo R. A comparison of intrathecal fentanyl and sufentanil for labor analgesia. Anesthesiology. 2002;96(5):1070–3.

    CAS  PubMed  Google Scholar 

  127. Concepcion M, Maddi R, Francis D, Rocco AG, Murray E, Covino BG. Vasoconstrictors in spinal anesthesia with tetracaine–a comparison of epinephrine and phenylephrine. Anesth Analg. 1984;63(2):134–8.

    CAS  PubMed  Google Scholar 

  128. Dobrydnjov I, Axelsson K, Samarütel J, Holmström B. Postoperative pain relief following intrathecal bupivacaine combined with intrathecal or oral clonidine. Acta Anaesthesiol Scand. 2002;46(7):806–14.

    CAS  PubMed  Google Scholar 

  129. Elia N, Culebras X, Mazza C, Schiffer E, Tramèr MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anesth Pain Med. 2008;33(2):159–67.

    CAS  PubMed  Google Scholar 

  130. Kim JE, Kim NY, Lee HS, Kil HK. Effects of intrathecal dexmedetomidine on low-dose bupivacaine spinal anesthesia in elderly patients undergoing transurethral prostatectomy. Biol Pharm Bull. 2013;36(6):959–65.

    CAS  PubMed  Google Scholar 

  131. Bromage PR. Mechanism of action of extradural analgesia. Br J Anaesth. 1975;47(suppl):199–211.

    PubMed  Google Scholar 

  132. Duggan J, Bowler GM, McClure JH, Wildsmith JA. Extradural block with bupivacaine: influence of dose, volume, concentration and patient characteristics. Br J Anaesth. 1988;61(3):324–31.

    CAS  PubMed  Google Scholar 

  133. Visser WA, Lee RA, Gielen MJM. Factors affecting the distribution of neural blockade by local anesthetics in epidural anesthesia and a comparison of lumbar versus thoracic epidural anesthesia. Anesth Analg. 2008;107(2):708–21.

    CAS  PubMed  Google Scholar 

  134. Bromage P, Burfoot M, Crowell D, Pettigrew R. Quality of epidural blockade. I. Influence of physical factors. Br J Anaesth. 1964;36:342–52.

    CAS  PubMed  Google Scholar 

  135. Reddy SV, Yaksh TL. Spinal noradrenergic terminal system mediates antinociception. Brain Res. 1980;189(2):391–401.

    CAS  PubMed  Google Scholar 

  136. Bonica JJ, Kennedy WF, Ward RJ, Tolas AG. A comparison of the effects of high subarachnoid and epidural anesthesia. Acta Anaesthesiol Scand Suppl. 1966;23:429–37.

    CAS  PubMed  Google Scholar 

  137. De Leon-Casasola OA, Lema MJ. Postoperative epidural opioid analgesia: what are the choices? Anesth Analg. 1996;83(4):867–75.

    PubMed  Google Scholar 

  138. Curatolo M, Petersen-Felix S, Arendt-Nielsen L, Lauber R, Högström H, Scaramozzino P, et al. Adding sodium bicarbonate to lidocaine enhances the depth of epidural blockade. Anesth Analg. 1998;86(2):341–7.

    CAS  PubMed  Google Scholar 

  139. Salinas FV, Sueda LA, Liu SS. Physiology of spinal anaesthesia and practical suggestions for successful spinal anaesthesia. Best Pract Res Clin Anaesthesiol. 2003;17(3):289–303.

    CAS  PubMed  Google Scholar 

  140. Lesser JB, Sanborn KV, Valskys R, Kuroda M. Severe bradycardia during spinal and epidural anesthesia recorded by an anesthesia information management system. Anesthesiology. 2003;99(4):859–66.

    PubMed  Google Scholar 

  141. Nortcliffe S-A, Shah J, Buggy DJ. Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo. Br J Anaesth. 2003;90(5):665–70.

    CAS  PubMed  Google Scholar 

  142. Butler R, Fuller J. Back pain following epidural anaesthesia in labour. Can J Anaesth. 1998;45(8):724–8.

    CAS  PubMed  Google Scholar 

  143. Chan YK, Gopinathan R, Rajendram R. Loss of consciousness following spinal anaesthesia for Caesarean section. Br J Anaesth. 2000;85(3):474–6.

    CAS  PubMed  Google Scholar 

  144. Palkar NV, Boudreaux RC, Mankad AV. Accidental total spinal block: a complication of an epidural test dose. Can J Anaesth. 1992;39(10):1058–60.

    CAS  PubMed  Google Scholar 

  145. Singh B, Sharma P. Subdural block complicating spinal anesthesia? Anesth Analg. 2002;94(4):1007–9, table of contents.

    PubMed  Google Scholar 

  146. Dahlgren N, Törnebrandt K. Neurological complications after anaesthesia. A follow-up of 18,000 spinal and epidural anaesthetics performed over three years. Acta Anaesthesiol Scand. 1995;39(7):872–80.

    CAS  PubMed  Google Scholar 

  147. Gazmuri RR, Ricke CA, Dagnino JA. Trigeminal nerve block as a complication of epidural anesthesia. Reg Anesth. 1992;17(1):50–1.

    CAS  PubMed  Google Scholar 

  148. Sprung J, Haddox JD, Maitra-D’Cruze AM. Horner’s syndrome and trigeminal nerve palsy following epidural anaesthesia for obstetrics. Can J Anaesth. 1991;38(6):767–71.

    CAS  PubMed  Google Scholar 

  149. Evans JM, Gauci CA, Watkins G. Horner’s syndrome as a complication of lumbar epidural block. Anaesthesia. 1975;30(6):774–7.

    CAS  PubMed  Google Scholar 

  150. Day CJ, Shutt LE. Auditory, ocular, and facial complications of central neural block. A review of possible mechanisms. Reg Anesth. 1996;21(3):197–201.

    CAS  PubMed  Google Scholar 

  151. Okell RW, Sprigge JS. Unintentional dural puncture. A survey of recognition and management. Anaesthesia. 1987;42(10):1110–3.

    CAS  PubMed  Google Scholar 

  152. Reynolds F. Damage to the conus medullaris following spinal anaesthesia. Anaesthesia. 2001;56(3):238–47.

    CAS  PubMed  Google Scholar 

  153. Radwan IAM, Saito S, Goto F. The neurotoxicity of local anesthetics on growing neurons: a comparative study of lidocaine, bupivacaine, mepivacaine, and ropivacaine. Anesth Analg. 2002;94(2):319–24, table of contents.

    CAS  PubMed  Google Scholar 

  154. Pollock JE. Neurotoxicity of intrathecal local anaesthetics and transient neurological symptoms. Best Pract Res Clin Anaesthesiol. 2003;17(3):471–84.

    CAS  PubMed  Google Scholar 

  155. Rigler ML, Drasner K, Krejcie TC, Yelich SJ, Scholnick FT, DeFontes J, et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg. 1991;72(3):275–81.

    CAS  PubMed  Google Scholar 

  156. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718–29.

    CAS  PubMed  Google Scholar 

  157. Camann WR, Murray RS, Mushlin PS, Lambert DH. Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesth Analg. 1990;70(2):181–4.

    CAS  PubMed  Google Scholar 

  158. Evans RW. Complications of lumbar puncture. Neurol Clin. 1998;16(1):83–105.

    CAS  PubMed  Google Scholar 

  159. González-Carrasco FJ, Aguilar JL, Llubiá C, Nogués S, Vidal-López F. Pneumocephalus after accidental dural puncture during epidural anesthesia. Reg Anesth. 1993;18(3):193–5.

    PubMed  Google Scholar 

  160. Halker RB, Demaerschalk BM, Wellik KE, Wingerchuk DM, Rubin DI, Crum BA, et al. Caffeine for the prevention and treatment of postdural puncture headache: debunking the myth. Neurologist. 2007;13(5):323–7.

    PubMed  Google Scholar 

  161. Basurto Ona X, Martínez García L, Solà I, Bonfill Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2011;8:CD007887.

    Google Scholar 

  162. Ghaleb A, Khorasani A, Mangar D. Post-dural puncture headache. Int J Gen Med. 2012;5:45–51.

    PubMed Central  PubMed  Google Scholar 

  163. Carter BL, Pasupuleti R. Use of intravenous cosyntropin in the treatment of postdural puncture headache. Anesthesiology. 2000;92(1):272–4.

    CAS  PubMed  Google Scholar 

  164. Carp H, Singh PJ, Vadhera R, Jayaram A. Effects of the serotonin-receptor agonist sumatriptan on postdural puncture headache: report of six cases. Anesth Analg. 1994;79(1):180–2.

    CAS  PubMed  Google Scholar 

  165. Gielen M. Post dural puncture headache (PDPH): a review. Reg Anesth. 1989;14(3):101–6.

    CAS  PubMed  Google Scholar 

  166. Lee LA, Posner KL, Domino KB, Caplan RA, Cheney FW. Injuries associated with regional anesthesia in the 1980s and 1990s: a closed claims analysis. Anesthesiology. 2004;101(1):143–52.

    PubMed  Google Scholar 

  167. Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med. 2010;35(1):64–101.

    CAS  PubMed  Google Scholar 

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  1. Department of Anesthesia, Toronto Western Hospital, Toronto, Canada

    Herman Sehmbi MBBS, MD, EDAIC, EDRA & Ki Jinn Chin MBBS, MMed, FANZCA, FRCPC

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  1. Herman Sehmbi MBBS, MD, EDAIC, EDRA
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  2. Ki Jinn Chin MBBS, MMed, FANZCA, FRCPC
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Correspondence to Ki Jinn Chin MBBS, MMed, FANZCA, FRCPC .

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Sehmbi, H., Chin, K.J. (2015). Neuraxial Blocks: Spinal and Epidural Anesthesia. In: Regional Nerve Blocks in Anesthesia and Pain Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-05131-4_41

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