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Background and Aims Regional anaesthesia techniques are effective and reliable instruments in Paediatrics. Given children’s naturally uncooperative behaviour, they are usually used in combination with deep sedation or general anaesthesia in order to obtain optimal surgical conditions. A greater, uncommon challenge emerges if the latter are contra-indicated and regional anaesthesia alone must be used. The following case displays the tools used to successfully anaesthetise an 11 year-old patient waiting for lung transplant using spinal anaesthesia only.

Methods An 11 year-old, ASA IV patient was proposed for circumcision due to obstructive uropathy and uncontrollable pain caused by severe phimosis. The patient had a previous history of chronic lung disease with global respiratory failure, resulting in long-term supplemental oxygen and non-invasive ventilation, and is currently waiting for lung transplant. We decided to perform a saddle block taking into consideration the patient’s medical history.

Results The anaesthetic technique was carefully explained to the patient and his father, which both understood and consented. Diazepam (7 milligrams total) was administered as part of his fixed medication before entering the operative room for surgery. Saddle block was performed using intrathecal bupivacaine (7.5 milligrams total). Non-pharmacologic anxiolysis methods – music and digital technologies – were used throughout surgery. The patient was conscious and under spontaneous ventilation during the whole procedure, which ran uneventfully.

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Abstract #36323 Figure 1

Intra-operative picture depicting a conscious child patient having surgery while watching his favourite cartoon

Conclusions The case demonstrates regional anaesthesia does have a role as primary anaesthetic technique in Paediatrics and should still be considered for cases in which combined techniques are not suitable or even possible.