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ESRA19-0306 The near horizontal vertebra and epidural
  1. S Diwan
  1. Sancheti Hospital for Specialized Surgery, Anesthesia, Pune, India


Background and aims The author reports 3 patients in which computed tomography (CT) was used for epidural catheter placement in a patient with severe congenital scoliosis. Previously 3 attempts for spinal anaesthesia failed. Postoperative period after a sole general anaesthetic and opioids was associated with persistent pain, nausea and vomiting.

Methods 3 patients with severe scoliosis scheduled for hip and knee surgeries had failed spinal anaesthesia during previous surgeries. Patients were not willing for a lumbar and sacral plexus block. After obtaining informed consent, CT guided lumbar epidural catheter placement was performed preoperatively.

The patients had severe dextrorotatory thoracic scoliosis with a Cobb’s angle of more than 60 degrees and a compensatory laevorotatory lumbar curve of more than 40 degrees. In the axial scan, L3 vertebral area was identified as most easy to be approached through the defect in the intervertebral foraminal route. At a distance of 3 cm from the L2-3 spinous process, the needle was directed towards the convexity. The epidural space was identified with a loss of resistance at a depth of 6 cm and was secured at 10 cm at skin. After a test dose (3 ml of 2% adrenaline: lidocaine), surgery was performed under sequential epidural anaesthesia.

Results The epidural provided adequate perioperative and postoperative pain relief for 48 hours in all 3 patients.

Conclusions Anatomic deformity is an independent predictor of difficulty in performing neuraxial anaesthesia. CT guided neuraxial anaesthesia is an alternative in such difficult situations for providing good perioperative, opioid sparing analgesia.

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