Sacral plexus catheter analgesia in a patient with traumatic sacral fractures and Tarlov cysts

Abstract

Summary We report the use of a sacral plexus catheter for continuous local anaesthetic infusion in a patient with a unilateral sacral ala fracture following a fall from a horse. Although sacral plexus blockade has been well described for lower limb surgery, an ultrasound‐guided continuous catheter technique for conservatively managed fractures has not been described. Despite appropriate oral analgesia, the patient reported severe pain, particularly in the right gluteal region, which meant she was unable to sit upright or take deep breaths. A sacral plexus catheter was inserted with ultrasound guidance and an initial bolus of 30 ml levobupivicaine 0.25% was delivered followed by infusion of 8 ml.h−1 levobupivicaine 0.125%. Daily follow‐up and assessment were provided by the acute pain team. We judged the procedure to be a success as measured by an improvement in mobilisation, deep breathing, cough and patient satisfaction.

Local anaesthetic resistance in a patient with Ehlers‐Danlos syndrome undergoing caesarean section with continuous spinal anaesthesia

“…There is, however, no suggestion that patients with Ehlers-Danlos syndrome are at an increased risk of inadvertent dural puncture during lumbar epidural insertion [9]. There is, however, an increased incidence of Tarlov cysts in these patients, which are sometimes in communication with cerebrospinal fluid [10].…”

Airway management, regional anaesthesia and critical incidents: reports in anaesthesia

“…A sacral plexus catheter was inserted in a patient with a known history of Tarlov cysts who had sustained traumatic sacral fractures following a fall from a horse. We believe this to be the first description of a sacral plexus catheter employed for acute pain management following a pelvic fracture . These two regional anaesthesia reports are a demonstration of applying anatomical knowledge with recognised techniques to good effect in novel clinical settings.…”