Management of a case of ankylosing spondylitis for total hip replacement surgery with the use of ultrasound-assisted central neuraxial blockade

Abstract

Management of a case of ankylosing spondylitis can be very challenging when the airway and the central neuraxial blockade, both are difficult. Ultrasound-assisted central neuraxial blockade may lead to predictable success in the field of regional anaesthesia. We present a young patient with severe ankylosing spondylitis where conventional techniques failed and ultrasound helped in successful combined spinal–epidural technique for total hip replacement surgery.

Combined Fascia Iliaca and Sciatic Nerve Block for Hip Surgery in the Presence of Severe Ankylosing Spondylitis

“…Two articles were excluded because of insufficient information, 6,7 leaving 16 articles (summarized in Table 1). 3,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] A total of 23 patients received 29 hip surgeries and anesthesia, including 26 hip replacements, 1 revision of a total hip replacement, 16 1 removal of infected hip prosthesis, 15 and 1 surgical wound debridement of an abscess of the right hip. 18 Twenty-three surgeries were performed under general anesthesia, with 4 initially planned for central neuraxial blockade but converted to general anesthesia because of failed central neuraxial blockade.…”

“…18 Twenty-three surgeries were performed under general anesthesia, with 4 initially planned for central neuraxial blockade but converted to general anesthesia because of failed central neuraxial blockade. 12,14,15,22 Airway management was difficult in several patients of those 23 receiving general anesthesia, requiring a variety of airway adjuncts (including GlideScope, Airtraq laryngoscope, bougie, and laryngeal mask airway). Six surgeries were performed under regional anesthesia, including 1 under caudal anesthesia, 8 2 under combined spinal-epidural anesthesia, 13,22 and 3 under spinal anesthesia.…”

“…12,14,15,22 Airway management was difficult in several patients of those 23 receiving general anesthesia, requiring a variety of airway adjuncts (including GlideScope, Airtraq laryngoscope, bougie, and laryngeal mask airway). Six surgeries were performed under regional anesthesia, including 1 under caudal anesthesia, 8 2 under combined spinal-epidural anesthesia, 13,22 and 3 under spinal anesthesia. 9,17,18 Two were performed under ultrasound guidance, 17,22 and 1 used minilaminotomy for spinal anesthesia.…”

Management of ankylosing spondylitis case for ankle surgery under spinal anaesthesia by Taylor’s approach

“…Ankylosing spondylitis [AS] is a chronic inflammatory disease of axial skeleton and peripheral joints [1]. The inflammatory process usually begins at the sacroiliac joints and spread upwards to involve the spine and costo-vertebral joints leading to classical 'bamboo' spine.…”

“…On cardiovascular examination she had mid systolic click, on further investigation -2D ECHO showed mitral valve prolapsed, her chest x ray showed multiple fibrosis shadow, she was diagnosed as severe ankylosing spondylitis with extra articular manifestations. Fig [1] Airway was anticipated to be difficult because of the lack of extension of the cervical spine. A difficult airway cart was kept ready along with a flexible fiber-optic bronchoscope.…”