Organisation of the Body
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show | A narrow, hollow syringe
a drug
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Biers Block | show 🗑
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show | Skin
Fat
Interspinous ligament
Ligamentum flavum
Epidural space
Dura
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Where is a spinal anaesthetic injected into? | show 🗑
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show | 7 cervical vertebrae
8 cervical spinal nerves
12 Thoracic vertebrae and spinal nerves
5 lumbar vertebrae and spinal nerves
5 sacral nerves
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show | Between L1/L2 in an adult
It initially reaches the end of the spine but regresses during development
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Cauda Equina | show 🗑
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show | L4 is level with the top of the pelvis, so can be used to identify the correct injection site
The patient should be flexed forward to allow access to the dura membranes which are usually covered by bone
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show | By identifying which nerve innervates the area of the body we want to numb, we can identify what area of the spinal cord we need to direct the anaesthetic to
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Drugs used in spinal anaesthesia | show 🗑
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show | Small - 2-3ml
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show | Into the lumbar CSF which bathes the cauda equina in the region L2-L5
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Time course of spinal anaesthesia | show 🗑
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show | Lock all nerves and modalities below the level of the injection, typically T10 downwards
Small nerves (temperature and pin prick sensations) are blocked before larger nerves (voluntary motor)
Spread depends on posture
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Adverse effects of spinal anaesthesia | show 🗑
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Uses of spinal anaesthesia | show 🗑
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Where is an epidural performed | show 🗑
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Drugs used in epidurals | show 🗑
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Volume of drug used in epidurals | show 🗑
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Site of epidural | show 🗑
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show | Slow onset - 10-30 mins
Lasts up to 6 hours
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show | Block of all nerves and modalities in a band around the body at the levels reached by the injection
Typically T10-S1 for a lumbar epidural
Spread depends on posture
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Adverse effects of epidurals | show 🗑
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Uses of epidurals | show 🗑
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