Subarachnoid block in kyphoscoliosis: A reliable technique?

Misra, S. S.; Shukla, Aparna Wagle; Rao, Keshav Govind

doi:10.4103/0975-2870.194226

Cited by 5 publications

(7 citation statements)

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“…The causes of failed or patchy spinal block in kyphoscoliotic patients can be due to anatomical defect itself, lack of proper placement of the local anesthetic, drug incompatibility, drug density, and drug defects. [ 3 4 5 ] However, in our case, it failed due to the inability to detect sclerosis that prevented the spread of local anesthetic solution in the subarachnoid space. It was detected later on X-ray lumbar spine AP and lateral view [ Figure 1 ].…”

Section: Discussionmentioning

confidence: 75%

“…There are only a few case reports where fluoroscopy has been used to perform spinal anesthesia in such patients. [ 3 4 ] Fluoroscopy may aid in identifying the small accessibility window, thereby facilitating subarachnoid block in those inaccessible by the landmark technique. Gupta and Gupta conducted a case series of 10 patients where they used fluoroscopic-guided paramedian approach to subarachnoid block in patients with ankylosing spondylitis.…”

Section: Discussionmentioning

confidence: 99%

“…Restrictive lung disease, airway management, and cardiorespiratory embarrassment make general anesthesia hazardous, whereas regional anesthesia is met with technical problems due to an abnormal curvature of the spine. [ 2 3 ] We report an interesting and challenging case of a 65-year-old male with kyphoscoliosis presenting with a displaced right intertrochanteric femur fracture planned for open reduction and internal fixation (ORIF) under regional anesthesia. We also discuss the importance of preoperative radiology in helping the anesthesiologists in planning regional anesthesia.…”

Section: Introductionmentioning

confidence: 99%

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Anesthetic challenges in a patient with severe thoracolumbar kyphoscoliosis

2020

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Patients with thoracolumbar kyphoscoliosis present unique challenges to anesthesia. We report an interesting and challenging case of kyphoscoliosis presenting with a displaced right intertrochanteric femur fracture who was planned for spinal anesthesia. However, spinal anesthesia was not successful even with the use of intraoperative fluoroscopy. The patient was again planned for spinal anesthesia the next day after reviewing his preoperative lumbar X-rays, which were suggestive of severe canal stenosis and sclerosis of the spine at L 4 –L 5 and L 5 -S 1 level thus causing the failure of contrast to spread up. Using appropriate space (L 3 –L 4 ) after viewing X-ray, successful spinal anesthesia could be given. This report underscores the importance of reviewing the preoperative radiology of the diseased spine by the anesthesiologist to administer an effective and safe spinal anesthesia in such patients.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anesthetic challenges in a patient with severe thoracolumbar kyphoscoliosis

2020

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“…Other case reports also had unilateral block with Cobb angle >45°. [ 12 ] In our earlier study we also reported a case of unilateral block in scoliotic group. [ 11 ]…”

Section: Discussionmentioning

confidence: 92%

Thoracolumbar curve and Cobb angle in determining spread of spinal anesthesia in Scoliosis. An observational prospective pilot study

Ballarapu¹,

Nallam

Samantaray

et al. 2020

Indian J Anaesth

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Background and Aims: Disparity in spread of spinal anesthesia is a known complication in scoliosis patients. Our primary aim was to compare this disparity based on Cobb Angle and thorocolumbar spine curvature. Secondary aim was to calculate the appropriate lateral angulation of the spinal needle from midline for successful lumbar puncture. Materials and Methods: All poliomyelitis patients with scoliosis posted for lower limb orthopedic contracture release surgeries were enrolled into Group A (Cobb Angle <50°), Group B (Cobb Angle >50°), and on thoracolumbar curve into Group R (Right), Group L (Left). Group A, B, R, and L were studied for bilateral spread of spinal anaesthesia. Lateral angle of the spinal needle from midline was noted with Goniometer in groups A and B. Statistical analysis was done using unpaired t test and Chi-square test. Results: Failures in subarachnoid block (SAB) (unilateral anaesthesia/inadequate/patchy block) was significant in Group B ( P = 0.033). Segmental disparity in bilateral spread of spinal anaesthesia was significant in Group R with P value of 0.042. Approximate lateral angle for needle in Group A was (4.1 ± 2.45) and in Group B was (9.14 ± 2.45). Conclusions: The study showed that there was a strong correlation between right-sided thoracolumbar curve and the spread of spinal anesthesia

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“…5 But studies advocated spinal anesthesia in patients with scoliosis recently. [6][7][8] The present study was aimed to study spinal anaesthesia in patients with scoliosis at a tertiary hospital.…”

Section: Introductionmentioning

confidence: 99%

Study of Spinal anesthesia in patients with Scoliosis at a tertiary hospital

2021

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Background: Scoliosis is a complex deformity of the vertebral spines resulting in lateral curvature, rotation of the vertebrae and deformity of the rib cage. 75 -90% of cases of scoliosis are of the idiopathic type, out of which the adolescent type is most common. Patients with scoliosis present challenges in administration of anesthesia during surgical procedures. The common problems are airway management and respiratory conditions. Aims and Objectives: The present study was aimed to study spinal anaesthesia in patients with scoliosis at a tertiary hospital. Materials and Methods: The present study was a prospective, observational study conducted in department of anesthesiology, in patients between age group 18 and 60 years with scoliosis (Cobb’s angle of >15°), American Society of Anesthesiology physical grade I/II, posted for elective, lower limb orthopedic soft tissue release procedures under spinal anesthesia. All details were noted in case proforma and entered in Microsoft excel sheet. Statistical analysis was done using descriptive statistics. Results: A total of thirty-two patients were included in present study. The mean age was 25.27 ± 4.81 years. Male (63%) were more than female (37%). Male to female ratio 1.7:1. As per American society of anaesthesiologist physical grading grade I patients were 78% while grade II was 22%. The onset of sensory block was in 7.9 ± 2.3 mins and onset of motor block was in 4.9 ± 2 mins. Maximum extent of sensory blockade till T5-T4 was noted in 66% patients. Time taken for complete recovery of motor block to its preoperative level was 94.3 ± 26.2 min. Conclusion: With proper preoperative assessment, spinal anesthesia can be safely used in patients with scoliosis. Patients with scoliosis needs good preoperative assessment, well equipped setup and team efforts for good outcome.

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Subarachnoid block in kyphoscoliosis: A reliable technique?

Cited by 5 publications

References 0 publications

Anesthetic challenges in a patient with severe thoracolumbar kyphoscoliosis

Anesthetic challenges in a patient with severe thoracolumbar kyphoscoliosis

Thoracolumbar curve and Cobb angle in determining spread of spinal anesthesia in Scoliosis. An observational prospective pilot study

Study of Spinal anesthesia in patients with Scoliosis at a tertiary hospital

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