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B232 Continuous spinal anesthesia for xypho-umbilical incisional hernia surgical repair: a case report
  1. N Carrillo-Alfonso1,
  2. C Cruz Ferreira2 and
  3. M Ramón Perez3
  1. 1Centro Hospitalar Universitário do Algarve, Faro, Portugal
  2. 2Centro Hospitalar e Universitário do Porto, Porto, Portugal
  3. 3Hospital Senhora da Oliveira, Guimarães, Portugal


Background and Aims Continuous Spinal Anesthesia (CSA) produces and maintains spinal anesthesia by titrating small doses of local anaesthetic into the subarachnoid space.

Methods 80 year-old-male, ASA 3, grade 2 obesity, with moderate OSA and restrictive pulmonary disease, arterial hypertension and cerebrovascular disease. Difficult airway predictors included Mallampati 4, OSA, short distances and large neck.

He was previously submitted to an open right hemicolectomy with GA. Towards the previous pathology and type of surgery, intensive care was required afterwards. Due to incision infection, re-intervention was required, resulting in a xypho-umbilical incisional hernia.

Two years later, he was scheduled for hernia correction. CSA was performed with standard monitoring (with invasive arterial pressure monitoring). The technique was conducted with a Tuohy epidural set (18G needle) and 3 cm of 20G catheter was introduced, cephalad oriented, without complications. A sensory T9 level was established with 5 mg of hyperbaric bupivacaine. Subsequently, a top up increment of 1mg of isobaric bupivacaine accomplished a sensory T6-L2 level, without haemodynamic instability. At the end of the procedure, a total of 3 mg isobaric bupivacaine was used and the catheter was removed. For postoperative analgesia, conventional analgesia without opioids was prescribed. He was discharged 4 days after, without neurologic complications or postdural puncture headache.

Results CSA allowed a sensory block suitable for the abdominal wall surgery with minimum impairment of the basal pathology of the patient.

Conclusions CSA is considered an alternative to GA for abdominal surgery in whom general anesthesia could increase morbi-mortality.

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