Ultrasound-Guided Epidural Anaesthesia in a 73-Year-Old Female With Bilateral Osteoarthritis and a History of Difficult Epidural Placement: A Case Report

Osteoarthritis (OA) of the knee is highly prevalent in the elderly population and generally causes disabling pain and dysfunction. Thus, knee OA has become one of the most common indications for total knee replacement (TKR) surgery. Neuraxial anaesthesia management in patients could be very challenging when there is a previous history of difficult epidural placements. The anatomical deformities and degenerative changes can limit the precise positioning of needles and increase the complication rates. This is a case of ultrasound-guided epidural and spinal anaesthesia administration in a 73-year-old female with a history of bilateral OA of the knee with previous difficult epidural placement. The patient had severe OA with severe pain and significant limitations in function. Epidural catheter placement was difficult in a prior bilateral tibial fracture repair, and she needed general anaesthesia for the procedure. Preoperative imaging showed significant degenerative change and decreased intervertebral spaces, which could compromise the accuracy of conventional epidural placement techniques. Real-time ultrasound was used for both epidural and spinal anaesthesia. Intraoperative and postoperative analgesia was provided with bolus doses of bupivacaine following the test dose that confirmed correct catheter placement. On the third postoperative day, the patient was discharged with oral analgesics. This report describes the use of ultrasound guidance to overcome the anatomical obstacles and challenges in epidural and spinal anaesthesia. The use of ultrasound guidance can contribute to a decrease in the complication rate, ensure adequate analgesia, and increase the accuracy of epidural treatment.