Spinal Anaesthetic Cheat Sheet for Nurses

Cheat sheet for Spinal Anaesthetic

1. What is a spinal anaesthetic? Spinal anaesthetic  is a technique that involves injecting a local anaesthetic solution into the intrathecal space and is frequently used to provide surgical anesthesia for procedures performed below the umbilicus (Sadler & Fettes, 2021).

2. Advantages of Spinal Anaesthetic Better pain management Reduced constipation Decreased need for opioids Reduced respiratory complications Quicker recovery Improved patient satisfaction (Hune et al, 2021)

3. Contraindications Patient refusal (absolute contraindication) Patients with increased intracranial pressure (absolute contraindication) Consumption of anticoagulant, antiplatelet or thromboyltic agents Infection to skin at needle site Bleeding disorders (Champange et al., 2023) Some Neurological conditions Obesity (Olawin & Das, 2022)

4. Complications Nause and vomiting Urinary retention ( if IDC not inserted) Post dural headache Hypotension Failed spinal block Vertebral canal haematoma Total spinal block Nerve damage Paralysis Cardiovascular and respiratory depression (Hune, 2021)

5. What do you need to prepare for a spinal anaesthetic? Sinal tray Sterile gown and gloves Sterile drapes Spinal needle Drawing up needles and syringes Cleaning solution e.g chlorohexadine prep stick, bethadine (check allergies ) Local anaesthetic +/- opioids Hudson mask Help for positioning patient Spinal trolly with spare equipment and reversal for local anaesthetic Follow anaesthetist preference for specific inclusions and make a clear plan with anaesthetist.

6. Important to remember - Aseptic technique –ACORN standards Spinal trolly only set up immediately before use Have the fewest number of people in the room that are needed Prepare the spinal site with antiseptic solution directly before incision –NICE guidelines

7. Dermatone Assessment Dermatone is the area of the skin that is supplied by a single spinal nerve. 5 groups of spinal nerves: Cervical, Thoracic, lumbar Sacral & Cocccygealt (Lee et al., 2008) High spinals can cause respiratory distress in PACU  Motor function-wiggle toes/lift legs off the bed Sensory function-move Ice along sternum moving side to side and downwards noting where the patient notes a cold sensation

8. PACU Considerations Vital observations-often hypotenisve Spinal observations-ICE for dermatone levels  puncture site for signs of haematoma Urine output  VTE Intrathecal morphine-must have oxygen therapy, must be charted on PCA chart  Reassurance

9. Reference list ACORN (2023) Standards for safe and Quality care in the Perioperative environment Champagne, K., Fecek , C., & Goldstein, S. (2023). Spinal opioids in anesthetic practice. In StatPearls . StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555912/ Hunie , M., Fenta , E., Kibret , S., & Teshome, D. (2021). The current practice of spinal anesthesia in anesthetists at a comprehensive specialised hospital: A single center observational study. Local Regenerative Anesthesia, 14 , 51–56. https://doi.org/10.2147/LRA.S300054 Lee, M. W. L., McPhee, R. W., & Stringer, M. D. (2008). An evidence-based approach to human dermatomes. Clinical Anatomy . https://doi.org/10.1002/ca.20636 NICE (2019)-Surgical site infections: prevention and treatment. Recommendations | Surgical site infections: prevention and treatment | Guidance | NICE Olawin , A. M., & Das, J. M. (2022). Spinal anesthesia. In StatPearls . StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537299/ Sadler, A. L. K., & Fettes, P. D. W. (2021). Spinal anaesthesia . Anaesthesia & Intensive Care Medicine, 22 (12), 781-784. https://doi.org/10.1016/j.mpaic.2021.11.00 2