Ultrasound as a Screening Tool to Plan Central Neuraxial Blockade for Total Hip Replacement in a Patient with Ankylosing Spondylitis: A Case Report

Authors: Yashoda Khadka* and Basudev Parajuli

DOI: 10.23880/accmj-16000217

Volume 8, Issue 1

Abstract

Patients with Ankylosing Spondylitis present unique challenges to anesthesiologists due to the fusion of their spines, making airway management and central neuraxial blockade difficult. This creates a dilemma during preoperative assessment regarding whether to plan the case in general anesthesia (GA) or regional anesthesia (RA). In our case, GA with endotracheal intubation was anticipated to be difficult due to the absence of neck motion, limited mouth opening, and restricted chest movement. Although central neuraxial blocks offer many advantages over GA, they are known to be difficult in patients with Ankylosing Spondylitis, and have been underutilized in the past. However, the possibility of avoiding GA and awake fiberoptic in an anxious patient, as well as excellent analgesia for both intraoperative and postoperative periods, prompted us to opt for RA. Despite the technical difficulty due to fused spines and obliteration of interspinal spaces, we successfully performed ultrasound-guided central neuraxial blockade for total hip replacement in this case.

Keywords: Ankylosing Spondylitis; Central Neuraxial Blockade; General Anesthesia; Total Hip Replacement; Ultrasound

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