Inadvertent epidural anesthesia associated with catheterization following continuous psoas compartment block in a patient with scoliosis: A Case report

Medicine
Byung-Gun KimKyungjoo Lee

Abstract

Psoas compartment block (PCB) is typically performed using surface anatomical landmarks and neurostimulation for guidance. However, anatomical anomalies, such as scoliosis, make this technique unreliable, posing a challenge for the anesthesiologist when inducing regional anesthesia. A 69-year-old woman with lumbar scoliosis scheduled for total hip arthroplasty underwent PCB with catheterization. Inadvertent epidural anesthesia with catheterization following PCB was diagnosed using a lumbar radiograph. Due to hypotension induced by local anesthetic (LA) epidural diffusion, the patient received intravenous hydration and vasopressor. Since bilateral sensory block was noted at the T3 level, with an incomplete motor blockade in both legs, the surgery was performed under epidural anesthesia. The patient remained hemodynamically stable throughout the duration of the surgical procedure. The surgery was uneventful and without further complications. Patients with lumbar scoliosis are highly at risk of LA epidural diffusion, following PCB using traditional landmark-based approach. Other nerve-localizing technique can minimize the risk of this complication.

References

Jul 1, 1976·Anesthesiology·D ChayenM Chayen
Nov 20, 2002·Anesthesiology·Gretchen Henkel
Mar 15, 2005·Regional Anesthesia and Pain Medicine·Xavier CapdevilaOlivier Choquet
Oct 24, 2008·British Journal of Anaesthesia·S T TourayR S G M Perez
Oct 27, 2010·Regional Anesthesia and Pain Medicine·Danielle Factor, Anahi Perlas
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Jan 13, 2015·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Christopher B RobardsRoy A Greengrass
Feb 17, 2017·British Journal of Anaesthesia·J M C StridT F Bendtsen

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Methods Mentioned

BETA
total hip arthroplasty
sedation

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