Table 1.

SAS Oxford Protocol Steps

Patient Selection	•Patient consents to procedure •No contraindication to spinal anaesthesia (including spinal stenosis above L2/3) •Patient lives within a reasonable distance from an emergency dept •Appropriate lumbar spine pathology
Preoperative Assessment	•Assessment at single multi-disciplinary clinic •Establish patients understanding of procedure and pathway •Specific SAS patient information leaflet (Figure 2) •Physiotherapy advice and leaflet •Orientation for day of surgery
Day Care admission	•IV fluid load •Pre-emptive analgesia •Empty bladder •Selection of intra-operative entertainment
Operative Stage	Scrub • Ready position before spinal administration • Correct theatre layout • Do not disturb signage
	Anaesthetics • Emergency equipment in theatre • TLIP equipment in theatre • Patient refreshments available
	Surgical • Table position bespoke to patient • Ancillary positioning devices available • Spinal top up prepared∗
Recovery	Recovery room • Check spinal level • Early discharge
	Day care ward • Early nutrition • Early mobilisation • Post-void bladder scan • Safety netting • Follow up plan
Adjuncts	Physiotherapy • Pre-operative leaflet and advice • Post operative visit if concerns
	Pharmacy • Activation of SAS e-prescription • Early preparation of discharge medications

^∗The spinal top-up is a mixture of 0.5% bupivacaine and fentanyl that is made available to the surgeon for direct intrathecal injection in the surgical field should the operation take longer than the spinal anaesthetic is effective for. It allows a controlled, incremental top-up of the spinal anaesthetic, and ensures the patient remains pain-free and comfortable throughout the procedure.