الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Spinal Anesthesia is generally regarded as one of the most reliable of regional block methods: the needle insertion technique is relatively straight forward, with cerebrospinal fluid (CSF) providing both a clear indication of successful needle placement and a medium through which local Anesthetic solution usually spreads readily. However, the possibility of failure has long been recognized (1). Failure of a spinal Anesthetic is an event of significant concern for both patient and Anesthetist even when it is immediately apparent, but it can have serious consequences (clinical and medico-legal) if the problem only becomes evident once surgery has started (1). If there is any doubt about the nature or duration of the proposed surgery, a method other than a standard spinal Anesthesia should be used (1). Literally, the word failure implies that a spinal Anesthetic was attempted, but that no block resulted; this happens, but perhaps a commoner outcome is that a block results, but is inadequate for the proposed surgery. Such inadequacy may relate to three components of the block: the extent, quality, or duration of local Anesthetic action, often with more than one of these being inadequate.
Summary
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This review has considered all three eventualities within the definition of ‗failure‘. In general terms, block failure is usually ascribed to one of three aspects: clinical technique, inexperience (of the unsupervised trainee especially), and failure to appreciate the need for a meticulous approach. In this review spinal anesthesia in children was discussed also. Spinal anesthesia is perhaps one of the oldest and well tested modalities for providing pain relief in patients undergoing surgery. Although the use of spinal or intrathecal anesthesia administration in children was described in the early 20th century, this technique was seldom used in the pediatric population until it was later reported in 1984 as a series of high-risk infants who underwent successful surgery under spinal anesthesia. Understanding of the anatomic and technical differences between adults and infants are crucial in order to safely, and in a technically proficient fashion administer spinal anesthesia in children (18). Neuraxial blockade traditionally has been accomplished using a surface landmark-guided technique in which the approximate location of the neuraxial midline and lumbar interspinous and interlaminar spaces are determined based on palpation of the intercristal line and the tips of the spinous processes (19).
Difficulty in performing neuraxial Anesthesia may result in neural injury, spinal haematoma, post-dural puncture headache, or
Summary
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infection. In addition, it may decrease procedure efficiency and increase patient discomfort and dissatisfaction (20). Reducing the technical difficulty of neuraxial blockade is desirable because multiple needle insertion attempts may increase the risk of complications such as postdural puncture headache, paresthesiae, and epidural hematoma (19).
Recently, newer minimally invasive imaging-guided percutaneous techniques have been added to the list of available treatment options for spinal pain and regional anesthesia. Imaging-guided techniques with fluoroscopy computed tomography or ultrasonography increase the precision of these procedures and help confirm needle placement (20)