9. ULTRASOUND-ASSISTED SPINAL ANESTHESIA AT L5-S1 IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Nguyen Duc Thien1, Ngo Van Thao1, Tran Thi Nuong1, Dao Thi Kim Dung1
1 Center of Anesthesia and Surgical intensive care, Viet Duc University Hospital

Main Article Content

Abstract

Background: Spinal anesthesia in patients with ankylosing spondylitis is a challenge for anesthesiologists. Spinal anesthesia at the L5-S1 interspace was described by Taylor in 1940 and was proven to be effective and safe. We evaluate the effectiveness and the side effects of ultrasound-assisted spinal anesthesia at L5-S1 in patients with ankylosing spondylitis.


Methods: Descriptive study on 16 patients with ankylosing spondylitis.


Results: L5-S1 interspace was seen in all patients on paramedian sagittal oblique view and in 7 patients (43.75%) on transverse interlaminar view. The time taken to identify landmarks was 153.56 ± 68.37 seconds, time taken to administer spinal anesthesia was 81.88 ± 14.17 seconds. Successful dural puncture at the first attempt in all patients. The maximum number of needle directions is 3 times, 6 patients did not need to change the needle direction during perform spinal anesthesia. The highest level of sensory block after 25 minutes was T4, and the lowest level of sensory block was T11. All patients in our study had complete loss of movement in the operated limb. Side effects: itching in 2 patients, vomiting and nausea in 1 patient, and shivering in 1 patient. No patient had hypotension during spinal anesthesia and surgery.


Conclusions: Spinal anesthesia in patients with ankylosing spondylitis can be performed safely and effectively with ultrasound-assisted.

Article Details

References

[1] Taylor John A, Lumbosacral Subarachnoid Tap, Journal of Urology, 43 (4), 561-564.
[2] Schelew BL, Vaghadia H, Ankylosing spondylitis and neuraxial anaesthesia-a 10 year review, Can J Anaesth, 1996, 43 (1), 65-68.
[3] Srivastava A, Arora A, Gupta D et al, Ultrasound-Guided Taylor's Approach in Ankylosing Spondylitis, Anesthesia, essays and researches,
2018, 12 (3), 761-764.
[4] David MH Lam, John CY Chan, Henry CY Mak et al, Use of Three-Dimensional Computed Tomography Reconstruction and RealTime Ultrasound-Guided Spinal Anaesthesia in a Patient with Ankylosing Spondylitis: A Case Report, International Journal of Clinical Studies & Medical Case Reports, 2021, 11 (1), 004.
[5] Goyal R, Singh S, Shukla RN et al, Management of a case of ankylosing spondylitis for total hip replacement surgery with the use of ultrasound-assisted central neuraxial blockade, Indian J Anaesth, 2013, 57 (1), 69-71.
[6] Chin KJ, Karmakar MK, Peng P, Ultrasonography of the adult thoracic and lumbar spine for central neuraxial blockade, Anesthesiology, 2011, 114 (6), 1459-1485.
[7] Srinivasan KK, Leo AM, Iohom G et al, Pre-procedure ultrasound-guided paramedian spinal anaesthesia at L5-S1: Is this better than landmark-guided midline approach? A randomised controlled trial, Indian J Anaesth, 2018, 62 (1), 53-60.
[8] Park Sun-Kyung, Bae Jinyoung, Yoo Seokha et al, Ultrasound-Assisted Versus Landmark-Guided Spinal Anesthesia in Patients With Abnormal Spinal Anatomy: A Randomized Controlled Trial, Anesthesia & Analgesia, 2020, 130 (3), 787- 795.