Combined segmental spinal epidural for major spine surgery: a case report

Area of Science:

• Anesthesiology
• Neurosurgery
• Spinal Surgery

Background:

• Neuraxial anesthesia is an alternative to general anesthesia for spinal surgeries.
• Patient preference and difficult airway concerns can influence anesthetic technique selection.
• Spinal fusion procedures like laminectomy with pedicle screw fixation require effective intraoperative and postoperative pain control.

Observation:

• A patient received combined epidural and spinal anesthesia for L4 laminectomy and L3-L5 pedicle screw fixation.
• Preoperative medication included buprenorphine and midazolam.
• An epidural catheter was placed at T8-T9, followed by segmental spinal anesthesia at T10-T11.
• The surgery lasted 6-7 hours, with epidural top-ups of lignocaine with epinephrine.
• Hemodynamics remained stable throughout the procedure with fluid and blood product administration.
• Postoperative pain was managed with continuous epidural infusion and systemic analgesics.

Findings:

• Combined epidural and spinal anesthesia was successfully implemented for a complex spinal surgery.
• Stable hemodynamics were maintained throughout the prolonged surgical procedure.
• Effective postoperative analgesia was achieved with epidural infusion, facilitating early recovery.

Implications:

• Neuraxial anesthesia can be a viable and safe option for patients with difficult airways undergoing spinal surgery.
• This technique may offer advantages in terms of postoperative pain management and potentially reduced recovery times.
• Further research could explore the broader application and long-term outcomes of neuraxial anesthesia in spinal fusion surgeries.