What drug do they use for a spinal block?

Question

And why does diamorphine make you itch?

Answer 1

We use local anesthetics (numbing medications) with or without opiates.

Most people I work with no longer use 0.75% bupivicaine in dextrose (heavy  - it's denser than spinal fluid so it sinks) for non-obstetric surgery, but use isobaric 0.5% bupivicaine.  It causes less of a drop in BP.  We still use the other for C-sections, though.

The use of lidocaine for spinals has decreased because of irritation of nerve roots that occurs in some people.  Lidocaine is great for short procedures, like cystoscopies or knee arthroscopy (with a surgeon who can move quickly).

Other drugs that can be used include tetracaine and procaine, and even preservative free meperidine (demerol), but they're not as commonly used.

Some add fentanyl to the spinal, and preservative free morphine can be added to provide analgesia overnight (and itching, unfortunately).

Opiates cause itching most likely through central effects (which is why naloxone is better than Benadryl at treating it).  You can read more here:

http://www.rch.org.au/pharmacy/drugs/ind...

Spinal = best anesthetic EVER.  Love 'em.

Answer 2

There are several options, but the commonest one is to use "heavy" bupivicaine ('heavy' because of the added dextrose to make the solution sink in CSF) - around 2 to 2.5 mls of 0.5% is usually enough.

Alternatively, you can use some fentanyl with the heavy bupivicaine.

Finally, you may wish to give a small local anaesthetic (usually using lignocaine) for the skin and subcutaneous tissues just prior to giving the actual spinal block.

Oh, the cause of itch with opiods is contraversial.  They cause histamine release (and histamine is well-known in causing you to itch) but there's probably also a central contribution in the brain to all the itching...

Answer 3

I got fentanly thru mine since Im allergic to morphine.

Fentanyl is AWESOME!

=D