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Epidural Anesthesia for Extracorporeal Shock Wave Lithotripsy in an Achondroplastic Dwarf
  1. Thomas T. Nguyen, M.D.,
  2. Peter J. Papadakos, M.D. and
  3. Lata U. Sabnis, M.D.
  1. Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
  1. Reprint requests: Peter J. Papadakos, M.D., Department of Anesthesiology, Box 604, University of Rochester Medical Center, Rochester, NY 14642.


Background and Objectives A 66-year-old achondroplastic male dwarf with right ureteral stones presented for outpatient extracorporeal shock wave lithotripsy under epidural anesthesia.

Methods The patient had marked lumbar lordosis and mild thoracic kyphosis. Although the epidural space was located easily at the L2-3 interspace on the first attempt, the catheter could not be advanced beyond the Tuohy needle. On the second attempt, the epidural space was located easily at the L1-2 interspace, and the catheter was advanced without difficulty.

Results A sensory block to the T2 level developed after administration of 2 mL of lidocaine 1.5% with epinephrine 1:200,000 and 9 mL of lidocaine 2.0% with epinephrine 1:200,000. Aside from a short period of mild, asymptomatic hypotension, the patient's intraoperative and postoperative courses were unremarkable.

Conclusions This case report and the available literature support the feasibility of epidural anesthesia in achondroplastic patients. Careful titration of the local anesthetic dose is recommended since achondroplastic patients may have extensive spread of epidural anesthesia.

  • epidural anesthesia
  • achondroplasia
  • extracorporeal lithotripsy

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