Info: SPINAL ANESTHESIA--Figure--Epidur
Structures that the needle will pierce before reaching the CSF
1.The skin. It is wise to inject a small bleb of local anaesthetic into the skin before inserting the spinal needle.
2.Subcutaneous fat. This, of course, is of variable thickness. Identifying the intervertebral spaces is far easier in thin patients.
3.The supraspinous ligament that joins the tips of the spinous processes together.
4.The interspinous ligament which is a thin flat band of ligament running between the spinous processes.
5.The ligamentum flavum is quite thick, up to about 1cm in the middle and is mostly composed of elastic tissue. It runs vertically from lamina to lamina. When the needle is within the ligaments it will feel gripped and a distinct "give" can often be felt as it passes through the ligament and into the epidural space.
6.The epidural space contains fat and blood vessels. If blood comes out of the spinal needle instead of CSF when the stylet is removed, it is likely that an epidural vein has been punctured. The needle should simply be advanced a little further.
7.The dura. After feeling a "give" as the needle passes through the ligamentum flavum, a similar sensation may be felt when the needle is advanced a further short distance and pierces the dural sac.
8.The subarachnoid space. This contains the spinal cord and nerve roots surrounded by CSF. An injection of local anaesthetic will mix with the CSF and rapidly block the nerve roots with which it comes in contact
Structures that the needle will pierce before reaching the CSF
1.The skin. It is wise to inject a small bleb of local anaesthetic into the skin before inserting the spinal needle.
2.Subcutaneous fat. This, of course, is of variable thickness. Identifying the intervertebral spaces is far easier in thin patients.
3.The supraspinous ligament that joins the tips of the spinous processes together.
4.The interspinous ligament which is a thin flat band of ligament running between the spinous processes.
5.The ligamentum flavum is quite thick, up to about 1cm in the middle and is mostly composed of elastic tissue. It runs vertically from lamina to lamina. When the needle is within the ligaments it will feel gripped and a distinct "give" can often be felt as it passes through the ligament and into the epidural space.
6.The epidural space contains fat and blood vessels. If blood comes out of the spinal needle instead of CSF when the stylet is removed, it is likely that an epidural vein has been punctured. The needle should simply be advanced a little further.
7.The dura. After feeling a "give" as the needle passes through the ligamentum flavum, a similar sensation may be felt when the needle is advanced a further short distance and pierces the dural sac.
8.The subarachnoid space. This contains the spinal cord and nerve roots surrounded by CSF. An injection of local anaesthetic will mix with the CSF and rapidly block the nerve roots with which it comes in contact
No comments:
Post a Comment