Target completion
6-8 minutes
Phase 1
Delegate and multitask for speed
Action
Delegate IV access + monitors
Phase 2
Sterile technique optimized for speed
Action
Mask, hat, sterile gloves
Single chlorhexidine wipe, dry; no sterile gown
Phase 3
Streamlined medication protocol
Action
Higher-dose hyperbaric bupivacaine; omit opioids
Phase 4
Limited attempts to preserve time
Action
One attempt only (second only if immediate correction obvious)
Phase 5
Surgical start on rising block
Action
Start surgery on rising block >=T10
Phase 6
Backup plan for inadequate block
Action
Immediate GA if block inadequate