Fluoroscopy Comes to the Rescue in Anaesthesia Management of a Case of Ankylosing Spondylitis

Abstract

Introduction: Ankylosing spondylitis is an anaesthetic challenge both from the airway and neuraxial point of view. The success rates as reported in literature while administering neuraxial anaesthesia in such cases are very low. We describe here such a case posted for total hip replacement. Case Presentation: A 25-year-old male patient was posted for right total hip replacement (THR) due to total arthrodesis of the right hip joint. He had a previous history of left THR done 1.5 yrs back. The patient was unable to sit erect and flexion and extension movements of the spine were painful. Both active and passive movements were severely restricted due to pain and stiffness, upto only 25- 30 degrees in the right hip joint and 45-50 degrees in the left hip joint and this has made him completely bedridden. For the anaesthetic management of this case, we combined fluoroscopy, a commonly used tool in chronic pain practice, into an-aesthesia practice by using it for the administration of epidural anaesthesia via inter-laminar approach in the prone position. The perioperative and post-operative course was uneventful. Conclusion: We conclude that fluoroscopy can be used in realtime as one of the most useful tools while administering neuraxial anaesthesia in difficult spine scenarios. Keywords: Ankylosing Spondylitis, Neuraxial Anaesthesia, Epidural Anaesthesia, Fluoroscopy, Total Hip Replacement.