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Continuous Spinal Anesthesia (CSA) for Cesarean Section in a Parturient with Bilateral total leg amputation：A Case Report
Abstract Number: T2D-4
Abstract Type: Case Report/Case Series
Background：The parturient with high-level amputation in lower limbs has low total blood volume，so blood loss is poorly tolerated. CSA produces and maintains spinal anesthesia by intermittent or continuous injection of a small dose of local anesthetic with subarachnoid catheter. CSA can provide more stable hemodynamic status with rapid onset and perfect anesthetic effect in obstetric patients.
Case report: A 33-year-old G2P1 woman was prepared for selective cesarean section at 38-week gestation. She had history of high-level bilateral total leg amputation because of severe trauma. During her first cesarean section，she had received combined spinal epidural anesthesia (CSEA)；and there was obvious hemodynamic fluctuation with a single dose of 0.5% ropivacaine (10mg) into subarachnoid cavity. Given this point，we planned CSA for her this cesarean delivery. A continuous spinal catheter（25G）was placed by a 21G needle at the L3-4 intervertebral space at the lateral position. Then the parturient was transferred to the supine position.0.3% ropivacaine（9mg with 10% dextrose in 3ml）was injected. Two minutes after injection，an T8 sensory level was obtained. 1ml ropivacaine (3mg) was administered again. A T5 level was obtained 6 minutes after the initial dose，then the operation started. But our patient suffered from uterine atony during the operation，and uterine contraction medications，intrauterine gauze tamponade，bilateral uterine artery ligation and additional improved B-Lynch suture was adopted to control uterine bleeding. Cardiac hemodynamic parameter-guided volume therapy and vasoactive agent(s) were used to maintain stable circulation. The total EBL was 1000ml. During the whole Operation，CSA offered perfect spinal anesthesia and the hemodynamics remained stable（Fig.1）. CSA was also used for pain management postoperatively. The intrathecal catheter was removed 24h after surgery. There was no adverse neurological sequelae and postdural puncture headache (PDPH).
Conclusion: Fears for PDPH and neuro-complications are the primary reason why CSA is infrequently used；however，the relative risk of this treatable side effect should be weighed against the many advantages of the technique in some specific obstetric anesthesia cases. In our case，CSA provided satisfactory analgesia and stable hemodynamics in parturient with high-level lower limbs amputation.