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Abstract
Background and aims Lumbar subarachnoid anesthesia (LSA) is rarely carried out on prone.1 2 Although the routine for subarachnoid block has been performed in spine flexion the prone position, increases the anatomic lumbar lordoses (figure 1). the paramedian lumbar puncture on this position makes it possible even without a ventral cushion.
Methods Male patient, 48 year-old, ASA I, arrived on prone at the Operating Room for debridement of his burned (posterior) legs (figure 2). the anesthetic procedure was explained and his informed consent obtained. Without ventral cushion, a peripheral venous access and classic monitoring (ECG, BP and oximetry) were adapted to the patient in head-down position at L3-L4, an LSA was performed. Lateral to the upper pole of L4 spinous apophysis the puncture was made with 27 G needle (figure 3a,b,c) which touched the vertebral lamina, ‘walked off’ until it reached the subarachnoid space. Finally, 12 mg of 0.5% of hypobaric bupivacaine (bp) was injected.
Results Anesthesia was successful due the anesthetic spray which reached the entire lumbar and entire lower limbs segments. Hypobaric blood pressure and head-down prone decubitus contributed with the anesthetic diffusion. the surgical debridement was complete. Vital signs remained stable. After the surgery, the patient was referred to the Anesthetic Recovery of the Burned Ward on the same prone decubitus.
Conclusions The seated or lateral decubitus are the most common positions for lumbar puncture. on the other hand, on ventral decubitus it is recommended to place a ventral cushion for better approaching the subarachnoid space.