and lower risks of deep venous thrombosis and pulmonary embo-
lus," he says.
Safe and effective
Dr. Li is a proponent of using ultrasound to place spinal blocks. She
finds it especially useful for obese patients. "Spinal anesthesia is per-
formed at the center of the back," she says. "When a patient is big,
sometimes it becomes difficult to know where the midline is."
Providers face the same issue with patients who are injured. "Hip
fracture patients are positioned lying flat on the side in the lateral
decubitus position," says Dr. Li. "For patients who have had multiple
spine surgeries, scar tissue and the implants make it difficult for you
to place spinal anesthesia. That's when the ultrasound becomes very
useful. We know where we should go, and it also tells us how deep
the spinal space is, so we can use the right needle going in and point it
in the right direction. Ultrasound can increase the success rate."
Successful application of spinal anesthesia also reduces the need for
intraoperative and postoperative opioid usage, according to Dr. Li.
"Patients who've had successful spinal anesthesia won't need opioids
for the duration of the surgery," she says. "In the recovery room, after
the spinal anesthesia starts to wear off, and even after the patient
starts to move around, there's still some pain control effect."
During surgery, hypotension could occur if blood pressure or heart
rate is low, or if the level of the spinal anesthesia is higher than it
should have been, says Dr. Li. This problem is not unique to spinal
anesthesia, she points out.
A recurring issue with spinal anesthesia isn't clinical. It's getting con-
sent from the patient to apply it. "One of the common contraindica-
tions to spinal anesthesia is a patient's flat-out refusal to get a needle
in their spine due to fear of nerve damage, but this risk is overblown,"
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