Ankylosing spondylitis: lateral approach to spinal anaesthesia for lower limb surgery

Kumar, Chandra M.; Mehta, Mani

doi:10.1007/bf03010575

Cited by 29 publications

(30 citation statements)

References 12 publications

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“…Paramedian No Yes Allen et al [19] 74/M AAA TEA-GA/T10-11 ? No No/EH Canakcı et al [23] 45/M Inguinal hernia SA/L3-4 Median No Yes Rodi et al [13] 42/M L2 vertebrae fracture EA/T11-L2 Paramedian No Yes Kumar et al [24] 28/M Knee surgery SA/L3-4 Paramedian No Yes Kumar et al [24] 52/M THR SA/L3-4 Paramedian No Yes Kumar et al [24] 42/M Knee surgery SA/L3-4 Paramedian No Yes Leung et al [14] 65/M Femur fracture SA/L3-4 Median Minilaminotomy Yes Weber et al [15] 29/M Anal fistula CA/sacral hiatus -No No Deboard et al [17] 50/M THR CA/sacral hiatus -No Yes Gustafson et al [20] 46/M Acute pancreatitis EA/T11-12 Median No Yes Robins et al [21] 63/M Duodenal surgery EA-GA/T7-8 Median No Yes Oyoma et al [18] 73/M THR EA/L3-4 Paramedian No Yes Jindal et al [25] 52/M Percutaneous nephrolithotomy SA/L5-S1 Taylor approach No Yes CABG: coronary artery bypass grafting; THR: total hip replacement; AAA: abdominal aortic aneurysm; C/S: cesarean section; SA: spinal anesthesia; EA: epidural anesthesia; CA: caudal anesthesia; CSEA: combined spinal and epidural anethesia; TEA-GA: thoracic epidural anesthesia and general anesthesia flow diagram (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…1). [8][9][10][11][12][13][14][15][17][18][19][20][21][22][23][24][25] Statistical analysis is summarized in Table 2. Most cases were males (16; 80%); the mean age of males was 51.9±13.4 years and that of females was 38.5±9.32 years.…”

Section: Resultsmentioning

confidence: 99%

“…[11,14,[22][23][24][25] Other techniques included thoracic epidural anesthesia (25%) [8,[19][20][21] , lumbar epidural anesthesia (15%) [9,13,18] , caudal anesthesia (10%) [15,17] , and combined spinalepidural anesthesia (10%) [10,12] .…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Review Of Neuraxial Anesthesia In Patients With Ankylosing Spondylitis

Öztürk

Özkan

Ergil

2017

EJMO

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Objectives: Ankylosing spondylitis is a rare disease that presents difficulties for general and regional anesthesia techniques in patients undergoing surgery. Thoracic kyphosis, flattening of the lumbar spine, and in patients with advanced stage AS, formation of syndesmophytes can complicate neuraxial anesthesia. This review examines spinal, epidural, and caudal anesthesia practices for patients with ankylosing spondylitis. Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, an electronic literature search was performed by three authors on 01.01.2017 without history limitation. English articles that reviewed neuraxial anesthesia applications for cases with ankylosing spondylitis were included. Results: In total, 17 articles with 20 patients were included. Most cases were males (16; 80%). Spinal anesthesia was performed for 40% of patients (thoracic epirak anesthesia, 25%; lumbar epidural anesthesia, 15%; caudal anesthesia, 10%; combined spinal-epidural anesthesia, 10%). A median approach was selected for eight patients (40%), whereas a paramedian approach was selected for seven patients (35%). Of the 20 approaches, three failed (15%). While the most application region was the thoracic region (45%; nine cases), generally (90%) no imaging technique was used. Conclusion: We believe that in patients with syndesmophyte formation in the thoracic or lumbar regions, the paramedian approach should be considered as a useful alternative to the median approach, or an imaging technique may also be used.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A Systematic Review Of Neuraxial Anesthesia In Patients With Ankylosing Spondylitis

Öztürk

Özkan

Ergil

2017

EJMO

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“…very little has been said about using paramedian approach for routine SA. Stray cases of using lateral approach for SA in ankylosing spondylitis have been reported [1,10,11], but its use in routine SA has not been advocated by any author. The outcome of this study was encouraging as can be seen from the results.…”

Section: Discussionmentioning

confidence: 99%

Lateral Approach : A Better Technique for Spinal Anaesthesia in the Modern Era

Khanduri

2002

Medical Journal Armed Forces India

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The most commonly used technique in routine spinal anaesthesia practke is the midline approach. compared to the lateral or paramedian approach. With the better understanding of the technique and introduction of fine gauge spinal needles. this practice needs a rethinking. Lateral approach was used in 60 patients undergoing different surgical procedures below the umbilicus, using 24 or 25 gauge, Quincke spinal needle without an introducer. The result was gratifying. In 77% of the cases the subarachnoid space could be entered in the first attempt. There was no failure. No patient complained of postdural puncture headache or post operative backache. Only one patient reported paraesthesia during needle placement without any residual effect. Various other advantages of the technique are discussed. Thus with due practice, lateral approach is found to be superior in modern day spinal anaesthesia.

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“…Convulsions secondary to accidental intra-osseous injection of bupivacaine during a caudal block and spinal haematomas following insertion of an epidural anaesthetic have been reported. Subarachnoid block using a lateral approach has been advocated as an alternative when general anaesthesia is contraindicated [58].…”

Section: Regional or Local Anaesthesiamentioning

confidence: 99%

Ankylosing spondylitis: recent developments and anaesthetic implications

Woodward

Kam

2009

Anaesthesia

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Summary Ankylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway, cardiovascular and respiratory complications, and the medications used to reduce pain and control the disease. There is also an increased risk of neurological complications in the peri‐operative period. Awake fibreoptic intubation is the safest option in those patients with a potentially difficult airway as it allows continuous neurological monitoring while achieving a definitive airway. Neurophysiological monitoring (somatosensory and motor evoked potentials) should be considered in patients undergoing surgery for cervical spine deformity. The medical management of the disease has improved with the use of anti‐tumour necrosis factor‐α agents. There is potential for increased wound infection in patients taking these drugs. This article reviews the anaesthetic issues in patients with ankylosing spondylitis. The challenge to the anaesthetist is in the understanding of these issues so that appropriate management can be planned and undertaken.

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Ankylosing spondylitis: lateral approach to spinal anaesthesia for lower limb surgery

Abstract: We describe three patients with long-standing ankyolsing spondylitis (AS)

Cited by 29 publications

References 12 publications

A Systematic Review Of Neuraxial Anesthesia In Patients With Ankylosing Spondylitis

A Systematic Review Of Neuraxial Anesthesia In Patients With Ankylosing Spondylitis

Lateral Approach : A Better Technique for Spinal Anaesthesia in the Modern Era

Ankylosing spondylitis: recent developments and anaesthetic implications

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