Spinal Cord Stimulator Insertion

Anesthesia Implications

Position: Prone, arms extended and flexed (“superman”)
Time: 1-2 hours (average)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No
Lead: Yes

Positioning – The patient will move to the bed and get into the prone position. make sure to have the patient position their head so they’re comfortable prior to sedating. This makes it easier to ensure the patient will remain comfortable.

Initial sedation – the physician will need to cut down initially and will want the patient well sedated. Thereafter, keep as light as possible. This will allow for easy intermittent wake-ups. Additionally, the prone position will be especially difficult to ventilate/intubate if the patient is too heavily sedated.

Intermittent wake-ups – Once the stimulator cords are in place, the patient will be temporarily woken up to assess the efficacy of the stimulator.

Prone Position (general considerations): Maintain cervical neutrality. Keep IV’s out of the antecubital space. The patients arms are typically flexed, which will kink the IV. Eye protection should be used as the prone position heightens the risk of corneal abrasion and/or traction on the globe (which can result in blindness). Check the patients eyes/ears/nose regularly throughout the case to ensure they are free of pressure. Positioning of the leads is typically high on the posterior and posterolateral back (somewhere free of pressure and out of surgical borders). Keep your connections and tubing where you’ll have fast access.

Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram – otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.