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ULTRASOUND-ASSISTED SUBARACHNOID ANESTHESIA IN SEVERE SCOLIOSIS
Author(s): ,
Graça, R.*
Affiliations:
Centro Hospitalar de Trás-os-Montes e Alto Douro, Department of Anesthesiology and Pain Medicine, Vila Real, Portugal
,
Cardoso, J.M.
Affiliations:
Centro Hospitalar de Trás-os-Montes e Alto Douro, Department of Anesthesiology and Pain Medicine, Vila Real, Portugal
,
Pinheiro, C.
Affiliations:
Centro Hospitalar de Trás-os-Montes e Alto Douro, Department of Anesthesiology and Pain Medicine, Vila Real, Portugal
Machado, D.
Affiliations:
Centro Hospitalar de Trás-os-Montes e Alto Douro, Department of Anesthesiology and Pain Medicine, Vila Real, Portugal
ESRA Academy. Graça R. Sep 13, 2017; 190758; 464 Topic: Spinal Anaesthesia - Analgesia
Rita Graça
Rita Graça

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Abstract
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Background and Aims:

Neuraxial ultrasound is a recent development in the regional anesthesia and is a useful complement for lumbar neuraxial blocks. It provides anatomical information that can be used to guide subsequent needle insertion, improving the precision and efficacy of neuraxial blockade reducing the risk of traumatic procedures.

We performed ultrasound-assisted subarachnoid anesthesia in a old woman with severe scoliosis.

Methods:

Woman, 89 years-old, ASA 2, 42 kg, with transient ischemic attack suspected many years ago and severe scoliosis, scheduled for a repair of subtrochanteric fracture with a long intramedullary nail. The patient had history of not achieved spinal block and she took acetylsalicylic acid regularly.

We performed ultrasound-assisted midline approach of subarachnoid anesthesia with levobupivacaine 0,5% 2,5 ml plus levobupivacaine 0,25% 5ml, using a quincke 27 gauge needle. The technique was achieved with only one no traumatic puncture. Was performed an analgesic femoral nerve block and lateral cutaneous nerve block. Intra-operative intravenous analgesia consisted of 1g paracetamol.


Results:

Neuraxial ultrasound identifies lumbar intervertebral levels, with greater accuracy than palpation of surface anatomical landmarks.

In our case, neuraxial ultrasound increased the efficacy of spinal anesthesia by decreasing the risk of failure and decreasing the number of needle punctures required in a patient taking acetylsalicylic acid regularly.

Conclusions:

By increasing the accuracy of needle placement and decreasing the number of needle passes, ultrasound may result in less traumatic procedures.

This technique hasn’t a long learning curve and don´t take too much time and could be a resource for the spinal anesthesia.

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