Successful Spinal Anesthesia = Skillful Needle Handling

For successful neuraxial blockade, it is not enough to just accurately identify bony spinal landmarks with ultrasound imaging - advancing the needle into the epidural/ intrathecal space requires that needle handling is also precise and accurate and systematic. This video covers several core principles I have found invaluable over the years, and is extracted from my video on neuraxial US imaging in the obese patient ( • Ultrasound Imaging in ... )
Complement it with my other video on needle handling - • Needle Handling Skills...

[@teely16]

Thank you for this timely video after failing a high BMI spinal.....

[@sertejo1]

Good work!! It's the first time that un Anaesthesia Theacher explains the "seeking" methode...it's not painful and very safe. Congratulations Dr Ki-Jinn Chin!!

[@TheDawch]

I'd like some more tips on skin marking, I find it quite challenging sometimes managing the ultrasound gel and marking. It can be a bit of a struggle trying to clean the gel off adequately to mark properly. Or do you use saline for that too, like your central lines?

[@KiJinnChin]

My suggestions: (1) start with just a little gel, and add to it only if needed (2) have a towel ready, and wipe area clean (3) make marks some distance away from the probe (as far as you can be without being inaccurate) (4) really clean off the area after you finish marking, and if you notice that marks are being wiped off, "reinforce" them with a clean marker before applying skin prep.
Saline is possible, but unlike vascular work, you may find yourself sliding the probe over a large area, and the friction now may become a hindrance rather than an advantage. You may find yourself applying lots of saline and soaking the surroundings.

[@TheDawch]

@@KiJinnChin thanks that’s very helpful