I believe giving Thoracic epidural is much more better than puncturing dura. You can only support the surgical timing if surgeon finishes surgery in time. But post op analgesia is limited to the effects of spinal anesthesia duration. In such major cases it will not help to continue analgesia for longer duration like 48-72hrs. Giving blind spinal also another drawbacks at this level. I don't know why anesthesiologists are not accepting C-arm as an armamentarium for their practice. In OT C-arm is available. Better to give high thoracic or cervical epidural under fluroscopy which is much more safer togive and epidural will support for everything from surgery to long duration post-op pain management. Chance of total spinal is not there in epidural as it ends at C1. As it's given blind, it's not safe to teach in a systematic way because you are not aware of depth. In every way now the time has come, all anesthesiologists should learn fluoroscopy guided epidurals to give more confidently and perfectly watching the depth of the needle which will tremendously help to take up risky cases confidently.
Excellent presentation sir. One query: Implications of segmental spinal anaesthesia in a patient with sepsis like the one with ruptured liver abscess in your presentation?
just touching has not been associated with any consequences, but if paresthesia is elicited then withdraw the needle and change the direction dont inject
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Good lecture on segmental anaesthesia
Excellent lecture.thankyou for sharing
I believe giving Thoracic epidural is much more better than puncturing dura. You can only support the surgical timing if surgeon finishes surgery in time. But post op analgesia is limited to the effects of spinal anesthesia duration. In such major cases it will not help to continue analgesia for longer duration like 48-72hrs. Giving blind spinal also another drawbacks at this level. I don't know why anesthesiologists are not accepting C-arm as an armamentarium for their practice. In OT C-arm is available. Better to give high thoracic or cervical epidural under fluroscopy which is much more safer togive and epidural will support for everything from surgery to long duration post-op pain management. Chance of total spinal is not there in epidural as it ends at C1. As it's given blind, it's not safe to teach in a systematic way because you are not aware of depth. In every way now the time has come, all anesthesiologists should learn fluoroscopy guided epidurals to give more confidently and perfectly watching the depth of the needle which will tremendously help to take up risky cases confidently.
can combine with epidural using CSE kits , or can take the help of USG. Either a preprocedural scan or USG guided
Well presented Sir very nicely explained.
Thanks dr Naresh from indonesia Surabaya
Excellent presentation sir.
One query: Implications of segmental spinal anaesthesia in a patient with sepsis like the one with ruptured liver abscess in your presentation?
Thank you for great video, i have a question: How about contraindications sir?.
same as those for lumber spinals
i am Awstruck👏👏👏
Sir we have only hyperbaric bupivacaine 0.5% how to make isobaric bupicacaine out of it ?!
Wonderful lecture DR. What's consequences of spinal needle touch spinal cord during thoracic spinal anaesthesia
just touching has not been associated with any consequences, but if paresthesia is elicited then withdraw the needle and change the direction dont inject
Sir is hypobaric levobupivacaine available in India or do you make it
you have to make it by adding distilled water
Wow ...😊