Successful Management of Ultrasound-Guided Combined Spinal-Epidural Anesthesia for Cesarean Section in a Patient with Achondroplasia

Anesthetic management of the pregnant achondroplastic patient for cesarean section poses significant challenges for anesthetists when coupled with anesthetic risks encountered during the third trimester of pregnancy. We report the case of a 25-year-old, 107 cm in height, and 37-week woman with achondroplasia who underwent neuraxial anesthesia for an elective cesarean section. Due to lumbar hyperlordosis and tissue edema, spinous processes could not be palpated and ultrasound probe was used to identify the vertebral interspace and also, the distance to the ligamentum flavum was measured. Accompanied by combined spinal-epidural (CSE) set, epidural space was located and a spinal needle was placed to the subarachnoid space. After 5 mg 0.5% hyperbaric bupivacaine with 10 μg fentanyl (total volume 1.2 mL) was injected to the subarachnoid space, the epidural catheter was advanced. A bilateral T5 sensory block level to pinprick was obtained after 5 min and the operation was allowed. A baby girl weighing 2460 gr was delivered 7 min after skin incision. The patient felt pain and discomfort during the elevation of the uterus and 3 mL 2% lidocaine was injected twice at 5 min intervals via the epidural catheter. The patient had no complications related to her delivery or anesthetic and was discharged home on the second postoperative day. CSE anesthesia with low spinal dose and ability to increase the level of the block via epidural route when needed, in combination with ultrasound guidance, provided successful and safe anesthesia.