Key Points Checking the anatomy with ultrasound before and during the procedure assures success. Because the sacrum is not fully ossified, it can still be penetrated by the ultrasound beams. Loss of resistance is not significant when placing an epidural…
Key Points In approximately 5% of adult patients, the sacral hiatus is nearly impossible to cannulate with needle or catheter. The tissue mass overlying the sacrum in some patients makes the technique difficult. The sacral hiatus lies at the tip…
Key Points Epidural block can be performed in cervical, thoracic, and lumbar regions of the vertebral column. Paramedian approach is the preferred technique for thoracic epidural, while median and paramedian approaches are suitable for lumbar epidural. T5–T6 interspace is the…
Key Points Spinal anesthesia is unparalleled in that a small mass of local anesthetic can produce dense surgical anesthesia. Bupivacaine is the ideal drug for spinal anesthesia. Identification of the lamina at 1 cm lateral to the spinous process is…
Key Points Prepuncture ultrasound scanning is helpful to determine the midline, the depth from the skin, the desired level, and rotation of the spine. There are limited outcome data on the real-time guidance with ultrasound for neuraxial blocks. The available…
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Key Points The subcostal transversus abdominal plane (TAP) approach is very useful for supraumbilical procedures. The most cephalad sensory dermatomal spread is T8. The bilateral continuous catheter infusion can be used in the upper abdominal surgeries where epidural analgesia is…
Key Points The transversus abdominis plane (TAP) block is a tissue plane block depending on adequate spread of local anesthetics through the plane—accordingly a minimum volume of 20 mL is usually needed for effective block. Frequent, small, incremental injections of…
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Key Points The thoracic paravertebral block, with or without catheter, can be used in lieu of thoracic epidural catheter for unilateral procedures and for breast surgeries. Pneumothorax is the major complication of this block. When performing the block and the…