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Spinal anaesthesia: Choice of local anaesthetic

Created: 26/10/2004
Updated: 26/7/2021

0.5% bupivacaine heavy (contains 8% dextrose) or plain may be used (2.5-3 ml). The spread of local anaesthetics in the subarachnoid space is dependent on:

 Speed of injection
 Size of the needle

Hyperbaric solutions (Specific gravity >1.009) will tend to spread caudad in patients in the sitting position and cephalad in patients in the Trendelenberg position. The intrinsic curves of the spine dictate that an injection made at L4 or lower with the patient in the supine position will tend to spread caudad and that an injection made at L3 or higher will spread cephalad. Hypobaric solutions (Specific gravity <1.003) will spread in the opposite direction.

The distribution of isobaric solutions (Specific gravity between 1.003 and 1.009) is generally unaffected by graavity and hence by patient posture.

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