A Narrative Review on Multimodal Spinal Anesthesia: Old Technique and New Use

Abstract

Spinal anesthesia has a long history in providing safe and effective anesthesia and analgesia. Its continuous evolution in block placement techniques with or without ultrasound assistance, options of spinal needles, local anesthetics and adjuvants adopted based on spinal anesthesia onset rate, duration of action, and side effect profiles, makes spinal anesthesia an important modality in current early recovery after surgery for a broad-spectrum of surgical procedures including ambulatory lower extremity orthopedic procedures and major chest, abdominal, and spine surgeries.

Keywords: adjuvant; local anesthetic; multimodal; spinal anesthesia.

Figure 1:

Historical timeline of spinal needles. Spinal needles were first used in 1855. Since the advent of the spinal needle, there have been various design modifications to reduce trauma and improve flow.

Figure 2:

This demonstrates the paramedian approach to spinal anesthesia in a longitudinal (2A) and cross-sectional (2B) view. Arrow pointing the direction of a spinal needle.

Figure 3:

Ultrasound-guided imaging of the spine. This illustration (3A) demonstrates the path of the ultrasound beam in a paramedian image. The intrathecal space can be viewed from a paramedian (3B) and transverse (3C) angle, as seen in ultrasound images. Top arrow, posterior complex; middle arrow, intrathecal space; bottom arrow, anterior complex.

Figure 4:

Historical timeline of continuous spinal anesthesia. Since the advent of continuous spinal anesthesia in 1906, catheters were developed and improved upon to reduce risk of complications.