Spinal Subarachnoid Block

■ Introduction of local anesthetic into the subarachnoid space

■ Used for uncomplicated cesarean delivery and vaginal delivery of normal women of low parity

■ Local anesthetics used include lidocaine and tetracaine.

Vaginal Delivery

■ Low spinal block

■ Level of analgesia extends to the tenth thoracic dermatome (corresponds to the level of the umbilicus)

■ Popular for forceps or vacuum delivery

Always pull back on the syringe prior to injection of anesthetic to look for blood flow into the syringe; if positive, you are in a vessel and must reposition your needle.

When vaginal delivery is anticipated in 10 to 15 minutes, a rapidly acting agent is given through the epidural catheter to effect perineal analgesia.

■ Provides excellent relief of pain from uterine contractions

■ Proceeded by infusion of 1 L of crystalloid solution ^ prevents hypotension

Cesarean Delivery

■ A higher level of spinal blockade is necessary to at least the level of the eighth thoracic dermatome (just below the xiphoid process of the sternum).

■ A larger dose of anesthetic agent is required to anesthetize the larger area ^ increased frequency and intensity of toxic reactions.

Complications with Spinal Analgesia

■ Maternal hypotension

■ Total spinal blockade

■ Spinal (postpuncture) headache

■ Convulsions

■ Bladder dysfunction

Contraindications to Spinal Analgesia

■ Severe preeclampsia

■ Coagulation/hemostasis disorders

■ Neurological disorders

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