Mastering Short-Spinal Anesthesia: WHY, WHEN, HOW
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- čas přidán 13. 12. 2023
- Secrets of Short-Spinal Anesthesia: In this enlightening video, delve into the world of short-spinal anesthesia and its groundbreaking impact on modern surgery. Discover how it revolutionizes joint replacement procedures by enhancing safety, reducing complications like deep vein thrombosis and pulmonary embolism, and facilitating faster patient recovery. Learn about the efficiency it brings to the operating room, reducing delays and improving overall surgical workflow. We also explore the advantages of short-acting local anesthetics such as chloroprocaine and prilocaine, their rapid action, and how they contribute to a smoother, more predictable recovery. Plus, understand the critical role of multimodal analgesia in managing post-anesthesia pain effectively. This video is an essential watch for healthcare professionals seeking to advance their knowledge and practice in anesthesia. Join us on this educational journey, brought to you by NYSORA's experts. Don't forget to like, share, and subscribe for more insightful content
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Our total joint surgeons aren’t anywhere near fast enough to get away with using chlorprocaine or mepevicaine in our spinals! 😂
Probably for the best. I really wouldn't want my THR surgeon racing against chloroprocaine.
Awesome video Dr. Hadzic! It is a GREAT subject to cast some light on, specially in the U.S. where everything is GA.
SA is highly effective and widely used in anesthesia practice in developing and underdeveloped countries. It is possible to perform even abdominal surgeries like open cholecystectomy or appendectomy and abdominal hernias.
It is fascinating what one can do with SA, but there are inherent limitations of the technique itself such as limited and unknown block duration. If the procedure takes longer than anticipated a conversion to GA may take place and some surgeons are not happy about it.
SA provides marked sympatholysis and in patients with relying on preload this may open a can of worms. The sympatholytic effects can be erratic and in patients with baseline bradycardia, the increased vagal tone resulting from SA can further worsen bradycardia and may lead to hemodynamic instability or even asystole.
It is also important to remember that the block it is not like flicking a switch. There is the onset of nociceptive block and after that you will still see some hemodynamic changes due PVR decease and HR changes. As anesthesia providers we must treat all these issues swiftly to ensure that all goes well, specially in the elderly patient in which things can start going south FAST.
IMHO it is good practice to perform PNBs after surgery completion to provide lingering post op analgesia in the first 24h post procedure. Good thing that they still have some degree of nociceptive block and don’t feel the skin puncture from the block needle :-)
I look forward to seeing more SA in anesthesia practice all over the USA. It is tireing that everything is GA.
Thanks dear Hadzic
Keep doing
We have been using Mepivicaine as a short acting spinal for same day discharge patients
ty dr hadzic.
Is Prilocaine approved by FDA for intrathecal administration? As far as I know that is an off label indication.
Also, have you had any problems getting Chloroprocaine supplies? We have been using it for a couple of years in our ASC but now the manufacturer (Braun) says that they are not making it any longer.
Fascinating topic and great presentation! Thanks!
Spinal anaesthesia is standard where I work. We have slow surgeons so we use 0.5 or 0.75 racemic bupivicaine. Our days to discharge are also very high so there are few incentives to use short acting spinals.
Which posoly of bupivacaïne do you use ? Do you add some opioïd ?
No tenemos en el país, AL de corta acción como los mencionados.
En caso de Cx's cortas (histeroscopias) usamos bupivacaina hiperbarica 10mg asociado a 25ugr de fentanilo => pronta recuperacion motora y buena analgesia posoperatoria.
Muy linda experiencia es NISORA!!!!.
Our hysteroscopies most often lasts up to 10 minutes. Very rarely - longer. So, in 99,9% we use intravenous anesthesia. Prpofol, fentanyl, oxygen via nasal cannula or face mask.
@@aedikunov Same, total in room time is like 30 min with setup/prep. Usually do an LMA or MAC
Great video
An interesting topic would be 2% intrathecal lidocaine and its TNS
Thank you
You recommended Prilocaine for Hip and knee arthroplasty except for DA Hip for which Chlorprocaine can be used. What’s the advantage of using prilocaine over Mepivacaine for Hip and Knee arthroplasty?
What are you using as a multimodal regimen for such cases at your centre sir?
Sometimes bupivacaine s not enough for sugeons 😅
For prilocain - it is better choice for a saddle block because of its hyperbaric properties.
Have you experimented with mixing in a small dose of bupivacaine 50-200 mcg to achieve prolonged analgesia without motor impairment. Also do you employ lateral position for performance of the SAB to intensify the block on the operative side for unilateral; orthopedic procedures. As a patient myself, I have had standard SAB several times and found it highly satisfactory.
For urologic procedures are you giving the whole 5 ml?
Is the SAB done in sitting or lateral position?
Isobaric chloorprocaine for saddle block - volume, patient positioning?
Or only hyperbaric prilocaine can be used?
This is one more example of academically excellent subject but practically fraught with many compounding factors: the surgeon is late, the surgery takes more than expected etc. In orthopedic surgeries for instance I use either unilateral spinal block with 1.5 ml Heavy Marcaine and some fentanyl or, if the patient cannot be positioned in lateral position than isobaric Marcaine 2 ml and some fentanyl. These doses are both enough for a surgery up to two hours (variable of course) and usually don’t produce severe drops in BP. I guess in shorter procedures like histeroscopies, diagnostic cystoscopies or arthroscopies yes, they can offer a benefit.
You can use half dose bupivacaine 0,5 % , ex 20 mg with adjuvan fentanyl 25 ug for short time surgery.
How about Lidocaine 5% hyperbaric?
In indonesia we use Iidokain 5% Lidodex,
In India, prilocaine is not available and chlorprocaine block density can be problematic.
All in all Hip Replacement dont happen here in such short time and parts preparation and painting and draping takes several minutes..
Any experience in using 0.75% lebobupivacsine intrathecally for prolonged block?
In Italy we use it.
10-12,5 mg.
Onset in about 10 to 20 minutes, duration of about 2 to 3 hours.
It induces less hypotension than bupivacaine but it's more important to check the patient's urine output after surgery
May be the problem is slow onset levobupivakain wesolve with added with adjuvant fentanyl 25 ug for surgery and 0,1 mg morfin for postop pain.
👍🙏
Are prilocaine and chloroprocaine FDA approved for spinal anesthesia? If not, what are the medico-legal implications of using them off-label?
Both are licensed in other developed countries and there is plenty of literature on their use.
Even if they are not FDA approved (I don't know if they are) their use would still be very defensible.
What if surgery takes longer than 60 minutes for whatever reason and the spinal anesthesia wears off?
Conversion to GA
No dispongo de prilocaina ni cloroprocaina. Dependiendo del procedimiento y hablando con el cirujano uso dosis menores de bupivacaina (0,75. 10 mg ) en ocasiones la lidocaina isobárica 50-80 mg.
La lidocaina isobarica al 2% va muy bien fura poco y se recuperan rapido
Ans: the hyperbaricity of prilocaine makes it better for saddle blocks
Could you tell me the dose of Bupivacain heavy for operation at the upper abdominal surgery like lipoma just above the umbilicus?
😂😂😂😂
For most of us working in orthopedic surgery with hip and knee replacement, this is something that is unfortunately useless. 60-90 min for hip or knee is just about enough. And if things go just a little bit wrong for the surgeon there is a really big stress for us due to the risk of spinal wearing off before the operation is done. Theoretically good and for some other types of surgery absolutely yes, but for us mortals, working in ordinary orthopedic hospitals unfortunately no go. And if on top of that in Scandinavia, then big no. 😅
Same here in Austria or Germany, we often have to wait for surgeons to arrive 20-30min after placing the spinal, with all prepping and draping most prosthetic surgeries would take too long. I also like to see that the patient is painless for the rest of the afternoon after e.g. Knee replacement.
Also - is it usual to have hip replacement as same day surgery..?
I was under the impression that Fentanyl increases the density of the block and not the actual duration
Currently work at a practice where hip and knee replacements are done under spinal following by induction of general anesthesia. This was jarring to see. Has anyone else encountered this?
no, nobody gave chloro or procaine to hip surg pts. im interested in cesarean section usage though...can these two be used for it. why are they mixing GA and spinal for hip ?
There is no need to make a general anesthesia before a spinal for those surgeries. I ve never heard about that
@@gastongazaba3867General before or after spinal sounds very peculiar. Sedation, however, with for example dexmedetomidine or propofol infusion is often a useful adjunct.
I have had 3 spinal anesthetics provided by my partners. They supplemented with propofol, and it was a completely pleasant procedure. I would think many patients would find being awake for joint replacement quite jarring. Adding propofol would also cover the tail of the spinal when everything doesn't' go quite to schedule during the surgery.
Are prilocaine and chloroprocaine FDA approved for spinal anesthesia or are you using them off-label. If so, what are its medico-legal implications?