Sukriti Atram Associate Professor, Department of Anesthesia, Grant Government Medical College and JJ Group of Hospital, Mumbai 400008, Maharashtra, India
Ganesh Sonawane Senior Resident Department of Anesthesia, Grant Government Medical College and JJ Group of Hospital, Mumbai 400008, Maharashtra, India
Shreyash Gosavi Junior Resident, Department of Anesthesia, Grant Government Medical College and JJ Group of Hospital, Mumbai 400008, Maharashtra, India
Address for correspondence: Sukriti Atram, Associate Professor, Department of Anesthesia, Grant Government Medical College and JJ Group of Hospital, Mumbai 400008, Maharashtra, India E-mail: sukritiatram@gmail.com
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Sukriti Atram, Ganesh Sonawane, Shreyash Gosavi. A Patient with Dorsal Scoliosis Posted for Transabdominal Hysterectomy Under Spinal and Epidural Anaesthesia. Ind J Anesth Analg. 2025; 12(2): 141-144.
Timeline
Received : March 10, 2025
Accepted : May 14, 2025
Published : June 30, 2025
Abstract
Patient with scoliosis for major surgeries like Total abdominal hysterectomy present challenges for anaesthesia owing to long surgery duration, pulmonary complications, Intubation in case of general anaesthesia; And un-predictability of sensory blockade in case of neuraxial anaesthesia. In this case, a 56-year-old female, with Thoracic scoliosis, presenting complaints of abnormal uterine bleeding, diagnosed with multiple uterine fibroids, posted for Transabdominal hysterectomy decided to take under neuraxial anaesthesia by assessing risk benefit ratio. The anaesthetic management must address intraoperative hemodynamic stability and post operative analgesia, which achieved successfully in this case. This case highlights importance of preoperative assessment, imaging and planning in managing patient with scoliosis for major surgeries. Key Messages: Thoracic scoliosis is condition with multisystemic involvement, which can cause difficulty in induction, maintenance of anaesthesia, and postoperative outcome in patients posted for major surgeries. Hence selection of anaesthetic technique should be appropriate.
References
1. Hudec J., Prokopová T., Kosinová M., Gál R. Anesthesia and Perioperative Management for Surgical Correction of Neuromuscular Scoliosis in Children: A Narrative Review. J Clin Med. 2023 May 24; 12(11): 3651. doi: 10.3390/jcm12113651. PMID: 37297846; PMCID: PMC10253354.
2. Rafiq M., Hussaini, Siraj S., Marium W., Talha S. Landmark based epidural anesthesia in a patient with scoliosis for transabdominal hysterectomy; a case report. Anaesth. pain intensive care 2024; 28(4): 762−764
3. Kulkarni A.H., Ambareesha M. Scoliosis and anaesthetic considerations. Indian J Anaesth. 2007; 51(6): 486-95.
4. Bajwa S.J., Bajwa S.K., Kaur J., Singh A., Bakshi G., Singh K., Panda A. Admixture of clonidine and fentanyl to ropivacaine in epidural anesthesia for lower abdominal surgery. Anesth Essays Res. 2010; 4(1): 9.
5. Goel, A., Jeelani, T.M., & Saleem, B. (2021). Study of Spinal anesthesia in patients with Scoliosis at a tertiary hospital. Asian Journal of Medical Sciences, 12(2), 44–48. Retrieved from https://www.nepjol.info/index.php/ AJMS/article/view/30935
6. Walcott B.P., Khanna A., Yanamadala V., Coumans J.V., Peterfreund R.A. Cost analysis of spinal and general anesthesia for the surgical treatment of lumbar spondylosis. J Clin Neurosci. 2015; 22: 539–543.
7. Kumar K.P. and Jagadesh G. Regional anesthesia in patients with scoliosis-A single centre clinical experience in India. MedPulse International Journal of Anesthesiology. 2018; 8(2): 65-69. https://doi.org/10.4103/0975- 2870. 194226
8. Klienman W. Spinal, Epidural, and Caudal Blocks. Clinical Anaesthesiology. 4th ed. New York: Mc Graw Hill Inc; 2006: 289-323.
9. Ozyurt G., Basagan-Mogol E., Bilgin H., Tokat O. Spinal anesthesia in a patient with severe thoracolumbar kyphosis. Tohoku J Exp Med. 2005; 207: 39-42.
10. Chin K.J., Perlas A., Chan V., Brown-Shreves D., Koshkin A. and Vaishnav V. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology. 2011; 115: 94–101.
11. Geng, Z.Y., Zhang, Y., Bi, H. et al. Addition of preoperative transversus abdominis plane block to multimodal analgesia in open gynecological surgery: A randomized controlled trial. BMC Anesthesiol 23, 21 (2023).
Data Sharing Statement
There are no additional data available. All raw data and code are available upon request.
Funding
This research received no funding.
Author Contributions
All authors contributed significantly to the work and approve its publication.
Ethics Declaration
This article does not involve any human or animal subjects, and therefore does not require ethics approval.
Acknowledgements
We would like to express our gratitude to the patients, their families, and all those who have contributed to this study.
Conflicts of Interest
No conflicts of interest in this work.
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Cite this article
Sukriti Atram, Ganesh Sonawane, Shreyash Gosavi. A Patient with Dorsal Scoliosis Posted for Transabdominal Hysterectomy Under Spinal and Epidural Anaesthesia. Ind J Anesth Analg. 2025; 12(2): 141-144.
This license enables
reusers to distribute, remix, adapt, and build upon the material in any medium
or format for noncommercial purposes only, and only so long as attribution is
given to the creator.
This license enables
reusers to distribute, remix, adapt, and build upon the material in any medium
or format for noncommercial purposes only, and only so long as attribution is
given to the creator.
Description: Radiographic examination of spine and chest revealed Scoliosis with primary thoracic curvature towards left side (Cobbs’s angle 42 degrees)
Heading
Description: Skin and subcutaneous tissue was infiltrated with 2 ml of 1% lidocaine at entry point and an 18-gauge Tuohy needle was
inserted in the suspected L2-L3 epidural space