History of saddle anesthesia:
Spinal anesthesia became more popular as new developments occurred, including the introduction in 1946 of saddle block anesthesia by Adriani and Roman-Vega. However, in 1947 the well-publicized case of Woolley and Roe (United Kingdom) resulted in two patients becoming paraplegic in one day. Across the Atlantic, reports of paraplegia in the United States similarly caused anesthesiologists to discontinue the use of spinal anesthesia.
The development of novel intravenous anesthetic agents and neuromuscular blockers coincided with the decreased use of spinal anesthesia. In 1954, Dripps and Vandam described the safety of spinal anesthetics in more than 10,000 patients, and spinal anesthesia was revived.
What is saddle anesthesia?
It is the spinal given in sitting position and the patient remains seatedfor 5-10 minutes till drugget fixed. As only sacral segments are blocked it can be utilized only for perianal surgeries. The advantage is that hemodynamic fluctuations are minimal and there is no possibility of high spinal.
How saddle anesthesia works?
When
performing a “saddle block,” the patient should remain in the sitting position
for at least 5 minutes after a hyperbaric spinal anesthetic is placed to allow
the spinal anesthetic to settle into that region. If a higher level of blockade
is necessary, the patient should be placed supine immediately after spinal
placement and the table adjusted accordingly.
Analgesia up to S1, usual puncture site between L4 and L5 or L5 and S1, the saddle blocks blocks the dermatomes at S2-S5 level.
Uses of saddle anesthesia:
The saddle anesthesia is usd for the surgeries at perineum like labor analgesia, hemmorrhoidectomy, gential serugries and urological procedures.
Side effects of saddle anesthesia:
Although the side effects of saddle anesthesia are mostly the same as with spinal anesthesa like headache if there is dural puncture reported, urine retention, backache, but the most toruble some side effects like high spinal or total spinal can be avoided as the local anesthetic solutions remains more in perineum (sacral) which indireclty can give a protection from cardiac arrests and other major hemodynamic unstabilities.
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