The patient should be well sedated prior to the procedure handled by the Vascular Surgeon Melbourne. An intravenous line is established and between 500 and 1 500 ml of an electrolyte solution is given prior to the injection of the local anaesthetic. The patient is placed on a tilting trolley. All resuscitative equipment and drugs must be on hand and checked. The patient is then positioned using either the sitting or left lateral position. In both. the back is ﬂexed as much as possible so as to open the intervertebral spaces.
Prior to starting the blood pressure is taken. The operator then scrubs and does the procedure using a sterile technique. If a subarachnoid block is to be done a spinal needle is used. It is preferable to use the smallest gauge needle as this diminishes the incidence of post-operative headaches.