COMBINED SPINAL EPIDURAL IN A PATIENT WITH SEVERE LUMBAR KYPHOSCOLIOSIS–AN ANAESTHETIC CHALLENGE

Veer Thakkar; K.R. Kulkarni; I.J. Namaji

Volume : VI, Issue : V, May - 2016

COMBINED SPINAL EPIDURAL IN A PATIENT WITH SEVERE LUMBAR KYPHOSCOLIOSIS–AN ANAESTHETIC CHALLENGE

Veer Thakkar, K. R. Kulkarni, I. J. Namaji

Abstract :

Patients with spine abnormalities present unique challenges to the anaesthesiologists. Spinal deformities may cause difficulties with both tracheal intubation and regional anesthesia. We report the anaesthetic management of such a case of severe lumbar kyphoscoliosis posted for vaginal hysterectomy. A 72 year old female patient with a history of spine surgery was posted for vaginal hysterectomy for 3rd degree utereo–vaginal prolapse. Because of the unexpected effect of local anaesthetic solution in severe kyphoscoliosis, a combined spinal and epidural anaesthesia technique was chosen to provide anaesthesia. At the L2–L3 interverteal space Inj. Bupivacaine 0.5% (Hyperbaric) 2.5cc + Inj. Fentanyl 25µg was deposited in the subarachnoid space and an 18G epidural catheter was placed 5cms inside the epidural space, using needle through needle technique, via a paramedian approach. A successful motor and sensory blockade at the level of T10 was achieved.