The growing use of neuraxial anesthesia techniques has led to increasing interest in the ergonomics and teamwork required for safe and effective technique. Growing evidence and recent professional guidance suggest that having a dedicated assistant at the bedside can measurably enhance both patient safety and procedural efficiency during neuraxial anesthesia injection.
Performing neuraxial anesthesia is a delicate task that requires both technical precision and continuous situational awareness. Any lapse in sterility, monitoring, or communication can lead to complications ranging from block failure to infection or hemodynamic instability. When an assistant is present, responsibilities can be shared, allowing the anesthesiologist to focus more fully on needle placement and the patient’s response during the injection of neuraxial anesthesia. The assistant can manage supporting tasks such as monitoring vital signs, handling equipment, or ensuring the patient remains properly positioned—functions that, while secondary, are critical to the success and safety of the procedure 1–3.
A well-integrated assistant anticipates each step of the neuraxial process. For spinal anesthesia, the assistant may handle sterile tray setup, manage patient support during positioning, or confirm the presence of cerebrospinal fluid before injection. During epidurals, they can help maintain a steady patient posture and handle aspirating or test dosing as needed. In both cases, the assistant also plays a key role in continuously observing the patient’s condition, ensuring timely recognition of any adverse effects or technical issues 4,5.
Evidence from clinical practice suggests that the presence of an assistant can improve the efficiency and safety of neuraxial anesthesia. Indeed, procedures tend to be faster, with fewer interruptions or repeated attempts. Sterile technique is easier to maintain, and patient comfort tends to improve due to reduced handling time. In addition, it is easier to identify issues such as hypotension, high spinal block, or unintentional dural puncture when another trained person is involved and actively engaged 6–8.
To be effective, assistants must be properly trained. This includes familiarity with the relevant anatomy, understanding of aseptic technique, and a working knowledge of the drugs being used. Many institutions now offer dedicated training modules or simulation-based learning to prepare assistants for real clinical settings. During training and clinical integration, however, clear role definitions and protocols are essential to ensure smooth teamwork and reduce the risk of miscommunication 9–11.
As expectations for procedural safety and efficiency continue to rise, the use of an assistant during neuraxial anesthesia is becoming a best practice. When well-trained and properly integrated, an assistant can significantly enhance the quality of care, reduce complications, and support a more focused and controlled anesthetic environment.
References
1. Olawin, A. M. & Das, J. M. Spinal Anesthesia. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
2. Operater. Spinal Anesthesia. NYSORA https://www.nysora.com/techniques/spinal-anesthesia-2/ (2018).
3. Overview of neuraxial anesthesia – UpToDate. https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia.
4. Anesthesia Assistant Program. The Michener Institute https://michener.ca/program/anesthesia-assistant/.
5. St. Maarten Medical Center > Patient Care > Patient Information > Anesthesiology > Spinal Anaesthesia. https://smmc.sx/Patient-Care/Patient-Information/Anesthesiology/Spinal-Anaesthesia.
6. Sun, E. C., Miller, T. R., Moshfegh, J. & Baker, L. C. Anesthesia Care Team Composition and Surgical Outcomes. Anesthesiology 129, 700–709 (2018). DOI: 10.1097/ALN.0000000000002275
7. Whitfield, S. 7 Ways Certified anesthesiologist assistants (CAAs) make a lasting impact beyond the operating room. https://www.aspiringcaa.com/impact.
8. Surgical Outcomes Equivalent Whether Physician Anesthesiologist Assisted by Nurse Anesthetist or Anesthesiologist Assistant. https://www.asahq.org/about-asa/newsroom/news-releases/2018/05/surgical-outcomes.
9. internationalmedicalaid. How to Become An Anesthesiologist Assistant: Training, Licensing, and Certification Requirements. International Medical Aid https://medicalaid.org/archives/1010745 (2024).
10. Filteau, L., Preston, R. & Seligman, K. M. A call to action—anesthesia assistants in Canada. Can J Anesth/J Can Anesth 71, 1580–1585 (2024). DOI: 10.1007/s12630-024-02813-2
11. Anesthesiologist Assistant – CAA | NEOMED. NEOMED – College of Graduate Studies https://www.neomed.edu/graduatestudies/anesthesiologist-assistant/.
