Rachianesthésie en chirurgie ambulatoire : nouvelles indications (podcast)

Spinal anaesthesia remains underused in day-case surgery commonly due to the expectation of a too long duration of the block. The availability of short-acting local anaesthetics makes it more appropriate in this setting. Ambulatory surgery does not increase the incidence of side effects of spinal anaesthesia when the technique is adapted to patient and surgical procedure. The doses of spinal bupivacaine and sufentanil should be less than 10 mg and 5 μg respectively. Unilateral block reduces the dose-requirement. Preservative-free chloroprocaine and prilocaine are particularly suitable for surgical procedure of less than 60 min and 90 min respectively. It is necessary to use 25 or 27 gauge pencil-point needles; patients should void before surgery; the bladder volume should be checked by ultrasonograpy in the PACU, excessive fluid infusion should be avoided, postoperative analgesia should be anticipated and postoperative nausea and vomiting prevented.