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Spinal Anaesthesia after Spinal Instrumentation...made easy by Ultrasound!
Abstract Number: S 66
Abstract Type: Case Report/Case Series
We present a case series of three patients in whom use of the ultrasound facilitated successful Neuraxial anaesthesia. Each of the patients had prior spinal surgery ranging in extent from multi-level lumbar spinal fusions to thoraco-lumbar spinal fusions.
This 30-year-old patient previously had two Caesarean deliveries under general anaesthesia after having been refused a regional anaesthetic in a different institution. This was because of a perceived contraindication to the technique on the basis that she had Spinal rods in situ for correction of scoliosis.
The second patient in this series described a psychologically traumatic previous experience where attempts at spinal anaesthesia had taken more than one hour. She had previous spinal instrumentation with spinal rods, which were subsequently removed and underwent spinal fusion and bone grafting.
The third patient in this series had initially been reluctant to undergo spinal anaesthesia, as it was her perception that it was contraindicated due to her spinal surgery. Following consultation with our team she agreed to an ultrasound guided regional technique.
All three had uncomplicated single shot spinal anaesthesia administered at a lumbar space with reasonably preserved anatomy, as pre-determined by ultrasound. Satisfactory anaesthesia was achieved in each case and post-operatively there were no adverse sequelae.
Anaesthetists confronted with a patient with prior spinal instrumentation often avoid Neuraxial anaesthesia. There are a multitude of different reasons for taking this approach including perceived difficulty and lack of success. Fears over medico legal consequences of adverse sequelae exist. Furthermore, there is a misconception amongst both physicians and patients that Regional Anaesthesia is contraindicated where there has been prior spinal surgery.
In one study only two of nineteen patients who had had anterior spinal surgery received regional anaesthesia for delivery.1
In our institution, we are very familiar with the use of ultrasound guided regional anaesthetic techniques. We feel that this case series highlights the benefit of using ultrasound in performing regional anaesthesia in technically difficult cases.
1. Lavelle WF, Demers E, Fuchs A, Carl AL. Pregnancy after anterior spinal surgery: fertility, caesarean section rate, and the use of Neuraxial anaesthesia. Spine J 2009; 9:271-4