Dual Epidural Technique in Kyphoscoliotic Patient Posted for Abdominoperineal Resection with End Colostomy- A Case Report

Abstract

Background: Kyphoscoliosis, a complex spinal deformity involving abnormal curvature in both the coronal and sagittal planes, presents significant challenges for anesthetic management, especially during major surgical procedures such as abdomino perineal resection (APR). The altered anatomy and potential for respiratory compromise make traditional anesthetic techniques inapt .

Case presentation and clinical discussion: In a case involving a 71-year-old patient scheduled for APR due to rectal cancer, a double epidural technique was planned to address the challenges posed by severe kyphoscoliosis. This approach involved the insertion of two epidural catheters at different levels of the spine to ensure comprehensive coverage of the surgical field. The thoracic epidural was used for anesthesia during the abdominal phase of the surgery, while the lumbar epidural provided anesthesia for the perineal portion. The patient received a combination of local anesthetics and opioids through the epidurals, resulting in excellent analgesia throughout the surgery and minimizing respiratory depression. The patient experienced stable hemodynamics and satisfactory pain control in the immediate postoperative period, with no complications related to the epidural catheters or the anesthetic management.

Conclusion : This case demonstrates the safety and effectiveness of the double epidural technique for patients with kyphoscoliosis undergoing complex surgeries like APR, highlighting the importance of individualized anesthetic planning and innovative techniques in managing high-risk patients.