Regional anesthesia in patients with scoliosis -A single centre clinical experience in India
Journal Title: Medpulse International Journal of Anesthesiology - Year 2018, Vol 8, Issue 2
Abstract
Background of the study: Anesthesia in scoliotic spine is challenging because of the rotation of the vertebrae and indifferent spread of the drug following spinal blockade. The present prospective study was taken up to assess the safety of regional anesthesia and to assess the spread of 0.5% bupivacaine in moderate to severe kyphoscoliotic patients. Material and Methods: This study included 90 patients posted for lower limb orthopaedic soft tissue release procedures and divided into two groups i.e Group 1 with patients having Cobb’s angle<40 (n=52) while group 2 included patients with Cobb’s angle>40(n=38). Spinal anesthesia [Bupivacaine 2.5 ml(12.5mg)] was given with the patients positioned in the lateral with convexity of the spine to the lower side. After spinal anaesthesia, the patient was made supine with both the knees and hip flexed to correct the spinal curvature. Sensory level, motor blockade, onset of anaesthesia, duration and regression of sensory and motor blockade were assessed along with the spread of anaesthesia and achievement of spinal blockade.Results: The onset of sensory block was delayed(9.6 mins) in group 2 (Cobb’s angle>40) i.e when the curvature is more compared to group 1(7.2 mins) (Cobb’s angle<40) while the motor block was achieved earlier (5.6 mins) in group 2 patients (p<0.05) compared to group (6.4 mins). Time for 2 segment regression was faster (48 ± 28 min) in group 2 patients (p<0.05) compared to group 1 (52 ± 19 min). The quality of anesthesia, need for intra-operative sedation and satisfaction of the patients were adequate in both groups.Conclusion: Bilateral effective spinal blockade was achieved with flexion at the hips after giving spinal anesthesia thereby obliterating the spine curvature. With our experience of 90 cases, regional anesthesia can be safely given in moderate to severe scoliosis.
Authors and Affiliations
Koramutla Pradeep Kumar, G Jagadesh
Keywords
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