There are three ways to perform spinal anaesthesia; single injection, combined spinal-epidural, and continuous subarachnoid anaesthesia with small gauge spinal catheters. Single injection. Is the most widely used since it is easy to perform, safe, predictable, has low incidence of side effects, and low cost. The addition of adjuvants drugs to LAs provides sufficient time for more prolonged plastic surgical procedures, and therefore is the ideal technique in these patients.[3] Combined spinal/epidural. Combines the benefits of epidural and subarachnoid anaesthesia, lessening some of the disadvantages of both procedures. This technique allow us to titrate the upper sensory level, to reduce total dose of epidural LAs, and to continue anaesthesia as long as needed.[8,9] It is recommend for long plastic surgeries involving chest, abdomen and extremities in the same patient. Sometimes it is difficult to keep the epidural catheter in place, and it can also migrate outside the epidural space.[10,11] Continuous spinal anaesthesia. Described by Dean in 1907 [12] was reintroduced by Lemmon in 1940 [13]. The technique had several modifications until Hurley and Lambert [14] introduced the use of thin spinal microcatheters 32-gauge. Nowadays this procedure is underutilized due to several cases of cauda equina syndrome and the FDA recommendation to withdraw the technique. The main advantages of continuous spinal anaesthesia is to allow redosing of small amount of LA to prolong duration of anaesthesia/analgesia and provide better hemodynamic stability.[15] In the field of plastic surgery outpatient and short-stay cases it may be limited for older patients with prolonged procedures below Th8 dermatomes. Spinal anesthesia is done following anatomical landmarks. The introduction of ultrasound in regional anesthesia is an advanced technique that is now used in difficult cases where anatomy Spinal Epidural Spinal-epidural Anaesthetic Adjuvant Anaesthetic Adjuvant Anaesthetic

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