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Nicholas Greene believes that after nearly 70 years of usage, spinal anesthesia is still of sufficient merit clinically to warrant updating of his monograph on the physiology of this technique. Though recognizing my bias in favor of the method, I would nevertheless agree with him because further studies documented here on this form of regional anesthesia indicate an abiding clinical importance. But Greene, recognizing the competition posed these days by epidural anesthesia, offers a chapter on this method—the one major change over the first edition.
The physiological effects of spinal anesthesia arise largely from the effect the local anesthetic has on transmission of impulses in the neuraxis, autonomic fibers being most vulnerable. Thus, it is surprising to discover little that is new on the neurophysiology of subarachnoid block—or should we accept the obvious that there is not much to add in a conceptual sense? That the latter may be true
Vandam LD. Physiology of Spinal Anesthesia. JAMA. 1970;211(5):832. doi:10.1001/jama.1970.03170050066029