Monitoring

When a spinal is used, it is important to monitor the patient closely in case of side effects or complications. All routine modalities of monitoring should be continued.

Positioning

If hyperbaric local anaesthetic has been used, patient position can affect its spread. The sitting position will tend to cause blockade of the lower, sacral nerves ('saddle block'), whereas head down will tend to encourage higher spread. Lateral position can accelerate anaesthesia on the dependent side. If a spinal is performed in the sitting position, and the patient moved immediately supine, the natural lumbar lordosis can prevent the local anaesthetic spreading high enough. Hence, some practitioners place the patient in a lateral position before supine to enable upward spread of the solution (Fig 1).