Ultrasound-guided continuous spinal anesthesia for cesarean section in a parturient with scoliosis corrected with harrington's rod surgery

Abstract

With rapid improvement in healthcare in Saudi Arabia, increasing number of women with surgically corrected kyphoscoliosis are likely to present for cesarean section (CS) or vaginal delivery requiring anesthesia or analgesia. Despite the surgical correction, these patients have poor cardiopulmonary reserves which increase the risks associated with general anesthesia. Whereas altered vertebral anatomy from previous surgery and the presence of metal work in spine make performing of regional anesthesia (RA) difficult and unpredictable, we report anesthetic management of such a patient who underwent CS using continuous spinal anesthesia technique. Challenges of placement of a spinal catheter in such a patient are discussed, and use of ultrasonography to circumnavigate these challenges is described. We propose that ultrasound can prove extremely valuable in performing of RA in patients with surgically corrected kyphoscoliosis. We could not find a similar case report from Saudi Arabia in the published literature.

Anesthesia outcomes of pregnant women with spinal diseases: a single-center case-series study

“…Pre-puncture ultrasound examinations can provide crucial information such as the identification of the midline of the spine, precise intervertebral space, prediction of the depth of the epidural space, and determination of the needle insertion angle. This has established ultrasound guidance as a key tool for delivering high-quality healthcare [ 20 , 21 ]. Particularly in cases where patients are obese or palpation for landmarks is difficult, the use of ultrasound-guided punctures can reduce the risk of vascular puncture and decrease the incidence of postpartum back pain and headaches, demonstrating its significant advantages in enhancing safety [ 22 ].…”

Real-time ultrasound-guided neuraxial anesthesia for cesarean section in parturients with previous internal fixation surgery for lumbar fracture: a case series

“…Lavelle et al reported on 2 patients who received epidural anesthesia for CS after anterior spinal surgery (25). Majeed et al and Yeo et al reported that spinal anesthesia was successfully performed in parturients with scoliosis corrected with Harrington's rod surgery (26,27). Most parturients may benefit more from neuraxial anesthesia than from GA (24), and therefore, we chose neuraxial anesthesia for CS in parturients after lumbar fracture operations.…”

“…Many studies have demonstrated that US is helpful in identifying the puncture site and measuring the puncture depth when performing neuraxial techniques, which increases the success rate, particularly in technically difficult cases (24,(36)(37)(38)(39). Preprocedural US scanning of the spine may reduce the risk of technical difficulties in patients with a previous history of lumbar surgery (26,27,40). The spinal pedicle screw and rod fixation system can be easily recognized as strong reflectors in the median transverse and paramedian sagittal views.…”

Continuous spinal anaesthesia for caesarean section in a patient with peripartum cardiomyopathy

“…also removed catheter after surgery and the patient did not develop postdural puncture headache. [7]…”