Background and Aims Kyphoscoliosis is a complex deformity of the spine resulting in lateral curvature and rotation of the vertebrae and a deformity of the rib cage. There is usually secondary involvement of the cardio-respiratory and neurologic systems.
Neuraxial block is routinely performed without the aid of imaging modalities and approached blindly for placement of epidural catheter. Kyphoscoliosis poses a remarkable challenge to administration of neuraxial anaesthesia and may result in multiple pricks and complications such as nerve injury and hematoma formation.
We aimed to assess the feasibility and success of using fluoroscopy guidance for administration of epidural anaesthesia in a case of severe kyphoscoliosis.
Methods A 18-year-old female 132 cm tall, with severe kyphoscoliosis was posted for Cholecystectomy. She had severe dextrorotatory-thoracic scoliosis [Cobb angle- 62°] and a compensatory levorotatory-lumbar curve [45°]. Respiratory examination showed restricted breathing with B/L wheeze. PFT showed a restrictive pattern. Open cholecystectomy was planned under Epidural Anaesthesia. Serial MRI films were assessed to determine the direction of placement of the epidural needle which was enhanced with the use of fluroscopy guidance during the intraoperative period.
Results Intraoperative period assessed in terms of patient compliance and adequate surgical anaesthesia was satisfactory. Intraoperative use of analgesics was significantly reduced. Epidural analgesia was continued for 2 days postoperatively.
Conclusions Despite various challenges, this case of severe kyphoscoliosis was successfully managed with fluoroscopy-guided epidural anaesthesia. Fluoroscopy is a well-established imaging modality and its knowledge adds to the Anaesthesiologist armamentarium and offers an opportunity to provide neuraxial anaesthesia in patients with anticipated difficulty.
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