Managing Complications in Pregnancy and Childbirth: - IAWG

SPINAL (SUBARACHNOID) ANAESTHESIA P-11TABLE P-4Indications and precautions for spinal anaesthesiaIndications• Caesarean section• Laparotomy• Dilatation and curettage• Manual removal of placenta• Repair of third and fourth degreeperineal tearsPrecautions• Make sure there are no knownallergies to lignocaine or relateddrugs• Avoid use in women withuncorrected hypovolaemia, severeanaemia, coagulation disorders,haemorrhage, local infection, severepre-eclampsia, eclampsia or heartfailure due to heart disease• Review general care principles (page C-17) and start an IV infusion(page C-21).• Infuse 500–1 000 mL of IV fluids (normal saline or Ringer’s lactate)to pre-load the woman and avoid hypotension. This should bedone 30 minutes before anaesthesia.• Prepare 1.5 mL of the local anaesthetic: 5% lignocaine in 5%dextrose. Add 0.25 mL of adrenaline (1:1 000) if the anaestheticneeds to be effective for longer than 45 minutes.• Ask the woman to lie on her side (or sit up), ensuring that thelumbar spine is well flexed. Ask the woman to flex her head ontoher chest and round her back as much as possible.• Identify and, if required, mark the proposed site of injection. Avertical line from the iliac crest upward will cross the woman’svertebral column between the spines of the fourth and fifth lumbarvertebrae. Choose this space or the space just above it.Sterility is critical. Do not touch the point or shaft of the spinalneedle with your hand. Hold the needle only by its hub.• Inject 1% lignocaine solution using a fine needle to anaesthetizethe woman’s skin.• Introduce the finest spinal needle available (22- or 23-gauge) in themidline through the wheal, at a right angle to the skin in the verticalplane.Note: Fine needles tend to bend.