Ankylosing spondylitis (AS) is a chronic, progressive, autoimmune collagen tissue disease characterized by inflammation and lower back pain. General anesthesia may pose a high risk in the AS due to intubation difficulty, as well as affected respiratory and cardiovascular organs. In cases of involvement of the vertebrae, neuraxial anesthesia may be difficult or even impossible. In this article, we discuss a case of AS that received a successful an epidural catheter was placed using a transforaminal route under C-arm fluoroscopy guidance for total hip replacement surgery, which was difficult due to intubation and an interlaminar neuraxial anesthesia.

Fluoroscopically guided transforaminal epidural catheterization of the ankylosing spondylitis.

Epidural anesthesia is one of the easier and safer techniques for lower abdominal surgery. It has a very high success rate in the experienced hands, and failure rates are minimal when it is administered by the experienced anesthesiologists. As it is a blind technique, failures can be encountered even by a senior anesthesiologist in many situations and one must analyze retrospectively the various causes responsible for such failures. We report a case of 45-year-old female, weighing 60 kg, who was scheduled for elective vaginal hysterectomy under regional anesthesia. Initial four to five attempts were unsuccessful in establishing the epidural block as the epidural injection encountered bony resistance each time, but subarachnoid block could be achieved with a 23 G spinal needle in the paramedian site of entry in the third attempt. Postoperatively, lumbar and cervical spine X-rays were done which revealed an isolated lumbar spine bony fusion. She was diagnosed as a rare case of isolated lumbar spine fusion without any involvement of cervical spine, other articular joints or any systemic manifestations of diseases like ankylosing spondylitis.

Anaesthetic management of a vaginal hysterectomy case with an unanticipated failure of epidural injection due to fused lumbar spine.

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Anaesthetic management of a vaginal hysterectomy case with an unanticipated failure of epidural injection due to fused lumbar spine.