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#36333 Case report: hernia and beyond
  1. Sanghamitra Ghosh
  1. Anaesthesia, Sahyadri hospital, Pune, Maharashtra, India


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Background and Aims Use of Ultrasonography (USG) in performing regional blocks is well established. Many anaesthesiologist are still reluctant to use USG to identify landmarks in patients with distorted spinal anatomy. USG is as an effective tool and helps anaesthesiologist to identify various landmark in patients suffering with any kind of spinal deformity. Here we present a case of 52 years old patient posted for Cytoscopy and TURP with a huge right sided lumbar hernia containing right kidney and bowel loops, causing spinal deformity. This case report details the problems faced by anaesthesiologist in positioning the patient, difficulty in administering spinal anaesthesia and how difficult spinal anaesthesia was overcome with use of Ultrasound as guide for identifying various anatomical landmarks.

Methods This is a case report along with review of literature.

Results Experienced anaesthesiologist can visualize neuraxial structures with satisfactory clarity using USG. A preprocedural scan allows to preview the spinal anatomy, identify midline, locate a given intervertebral level, accurately predict the depth to space, and determine the optimal site and trajectory for needle insertion.

Abstract #36333 Figure 1

USG Report

Abstract #36333 Figure 2

X ray showing spinal deformity

Abstract #36333 Figure 3

Lumbar Hernia distorting spine curvature

Conclusions USG guided neuraxial anesthesia is noninvasive, safe, can be quickly performed, does not involve exposure to radiation, provides real-time images, and is free from adverse effects. USG guided neuraxial anesthesia is a rapidly developing alternative to traditional landmark-based techniques. In experienced hand USG can be an important tool in providing CNB in specific patients. As US technology continues to improve and as skills become more widely available, use of US for CNB may become the standard of care in future.

  • Lumbar hernia
  • spine sono
  • TURP

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