Spinal anesthesia, puncture position and local anesthetic solutions. Better understanding for better indication

Abstract

Two schools teach spinal anesthesia, one prefers the lateral decubitus position and the other the sitting position. The vast majority of anesthesiologists worldwide use routinely the hyperbaric solution of bupivacaine for almost all types of surgery, mainly performed in a sitting position. There is renewed interest in understanding spinal anesthesia about puncture position, the various solutions used, and the position of the operating table during the surgical procedure. Understanding the vertebral column, of the anterior and posterior roots, allows the different puncture positions, and the hyperbaric, isobaric, and hypobaric solutions to offer better quality of these techniques and will be shown in this article. The application of the three solutions in different puncture positions, and the position of the surgical table during the procedure, will be shown in seven items in 14 tables, and 6 figures, for the complete understanding of spinal anesthesia. The possibility of performing hemi-spinal anesthesia (unilateral and posterior), and the possibility of performing completely sensory spinal anesthesia without any degree of motor block are discussed. The explanations in this article with the different puncture positions and the three local anesthetic solutions are applied both in the lumbar region and in the thoracic region.