Regional Anaesthesia And Pain Mangment

,ANAESTHESIA DEPARTMENT ,HIGHER MEDICAL INSTITUTE .SIRTE, LIBYA

:ANATOMY :VERTBRAL COLUMIN-1 :It consist of 33 vertibrae, which are .cervical 7 .thoracic 12 .lumbar 5 .sacral 5 .coccygeal 4

: ANATOMY OF VERTIBRAE body: it is seperated from the other vertbral bodies by-1 .intervertibral disc .vertibral arch: covers spinal cord -2 .superior articular process , spinous process, trnsverse process-3 .pedicle-4 .spinal canal-5 The spinal cord: the spinal cord contains spinal cord with it's -2 coverings which is called ( the maninges), fatty tissu and venous .plexus

The maninges are compoosed of 3 layers .pia mater-1 .archnoid mater-2 .dura mater -3

The spinal cord consist of 31 segments : which are

cervical 8 thoracic 12 lumbal 5 sacral 5 .coccygeal 1 It extends from foramin magnum to the level of L1 in the adult. In .children it extends to the level of L3

:(CEREBRO SPINAL FLUID (CSF ,PH=7.4 :It's composed of .Protein=20mg%(mg/dl), it consist of albomine and glubuline .Glucose=2.5-4.4mmol/l %45-80mg= Csf pressure=70-180mmHg .Csf volume=135 ml 35ml in venricles .ml in cerebral sub archniod space 25 .ml in the spinal subarchniod space 75

:SPINAL ANAESTHESIA .It blocks nerve roots as they course through the subarchnoid space The spinal subarchniod space extends from foramin magnem to the .S2 in the adults and S3 in children Injection of local anaesthetic below L1 in adults and L3 in children .helps avoid dirct trauma to the spinal cord Spinal anaesthesia is also refered to the subarchniod block and . intrathecal injection .The position whch are preferred for spinal anaesthesia Midline: so the needle passes through-1 a-skin b-subcutanous tissue c-spraspnious ligment d-interspinious ligament e-ligmentum flvum f-dura mater and subarchniod mater g-subarchniod space h-inter laminr space .lateral postion :preferred in old patients-2 .paramedian, pron approach can be used-3

: The types of needles which are used .Quincke-1 .Whit acre-2 .Sprotte-3

:FACTORS AFFECTING THE LEVEL OF SPINAL ANAESTHESIA .Baricity of anaesthetic solution-1 .Position of the patient-2 .Drug dose-4 .Site of injection-5 .Age-6 .Pregnancy-7

: THE LOCAL ANAESTHETICS WHICH ARE USED .LIGNOCAIN-1 .PROCAIN-2 .BUPIVACAIN-3 .TETRACAIN-4