ila dan saddle block
DESCRIPTION
ILA SADDLE BLOCKTRANSCRIPT
Anestesi Spinal :ILA and Saddle Block
LUSI JELITA SARI
FK TRISAKTI
03011171
ANATOMY OF SPINAL CORD
33 Vertebrae◦7 Cervical◦12 Thoracic◦5 Lumbar◦5 Sacral◦4 Coccygeal
ANATOMY OF SPINAL CORD• Spinal Cord
– Adult• Begins: Foramen Magnum• Ends: L1
– Newborn• Begins: Foramen Magnum• Ends: L3
– Terminal End: Conus Medullaris– Filum Terminale: Anchors in sacral region– Cauda Equina: Nerve group of lower dural sac
Saggital Sections
Spinal MeningesDura Mater
◦Outer most layer◦ Fibrous
Arachnoid◦Middle layer◦Non-vascular
Pia◦ Inner most layer◦Highly vascular
Sub Arachnoid Space◦ Lies between the arachnoid
and pia
Physiology Of Childbirth
Stage I
Stage II
Stage III
Stage IV
Sources of Pain During Labour
DEFINITION
Indication of Spinal Anesthesia
• Lower extremity surgery
• Pelvic surgery
• Obstretrical surgery
• Rectum and perineum
• Urology surgery
• Lower abdominal surgery
Contraindications of Spinal Anasthesia
Absolute• Patient refused • Infection at the injection site• Coagulopathy• Severe hypovolemia• Increased intracranial pressure• Inexperience / unaccompained
consultanst• Severe hypotention
relative
• Sepsis• Uncooperative pasient• Neurological disorder• Severe spinal deformity
Complications
• Hypotention
• Bradycardia
• Vomiting, nausea
• High spinal
– Spinal head ache• More common in women ages 13-40• Larger needle size increase severity• Onset typically occurs first or second day post-op• Treatment:
– Bed rest– Fluids– Caffeine– Blood patch
Spinal Technique
• Preload with 500- 1000ml crystalloid• Premedicate Preparation & Monitoring
◦EKG◦NBP◦Pulse Oximeter
Patient Positioning◦ Lateral decubitous◦Sitting◦Prone (hypobaric technique)
• Mark the location of injection• sterilize
Drugs in Spinal Anesthesia
• hyperbaric
-Lidokaine 5% in dextrose 7.5%,
dose :20-50mg(1-2ml).
-Bupivakaine 0.5% in dextrose 8.25% ,
dose : 5-15mg(1-3ml).• Isobaric
-Bupivakaine 0.5% in water, dose : 5-20mg.
ILA (Intrathecal Labour Analgesia)
• Requirement
- Patient demand
- Informed consent
Drugs In ILA
• Fentanil
• Klonidin
• Buvipacain o,5% heavy
Indication of ILA
mother
• Labor pain• Long first stage of labor• Anxietas• Patient demand• Pregnancy with
abnormalities of the cardiovascular system
baby
• premature
Contraindications of ILA
• Patient refused
• Local infection
• Bleeding disorder
• Allergy
• Post SC
Saddle Block
• Indication of saddle block
- Perineum
- Buttocks
- Inner thighs
Saddle Block Technique
THANK YOU