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Introduction: This case report outlines a 38 week gestation, multigravida woman scheduled for elective caesarean section, with a history of spina bifida, associated neurological deficit, and a history of difficult intubation during her previous caesarean. This case describes successful anaesthesia for subsequent elective Caesarian section using an epidural technique with no associated complications. Case report: 36-year-old woman, G3P2, whose obstetric history included two prior emergency caesarean sections for IUGR and major placenta praevia. During her second caesarean, difficulty was encountered during intubation, where anaesthetists were able to obtain a view using the CMAC D-blade but difficulty feeding the endotracheal tube. She was seen at a tertiary hospital obstetric anaesthesia high risk clinic and both general anaesthesia (GA) and epidural options discussed. An MRI of her lumbosacral spine showed a low tethered cord, with the lowest margin of the cord at the mid-S2 level. On the day of surgery an epidural technique was agreed upon by the patient and anaesthetic team, after informed consent was obtained. After preparing the patient's back with antiseptic wash, and local anaesthesia was applied to skin, an 18gauge Touhy needle was used to locate the epidural space using a loss of resistance to saline technique. After single pass, the space was located at 5.5cm, and the catheter fed and secured. After negative aspiration of cerebrospinal fluid or blood was confirmed, a test dose of 0.2% Ropivacaine was injected via an epidural filter. Further increments of 5mL of 0.2% Ropivacaine + 2mcg/mL Fentanyl was used until adequate block was obtained to the T4 dermatome. A total of 15mL of solution provided adequate anaesthesia. Surgery was completed with no associated complications. Discussion(s): Spina bifida occulta is the most common neural tube defect, with an incidence of roughly 20%, and often is an incidental finding. Features of the disease that can impact ou

Introduction: This case report outlines a 38 week gestation, multigravida woman scheduled for elective caesarean section, with a history of spina bifida, associated neurological deficit, and a history of difficult intubation during her previous caesarean. This case describes successful anaesthesia for subsequent elective Caesarian section using an epidural technique with no associated complications. Case report: 36-year-old woman, G3P2, whose obstetric history included two prior emergency caesarean sections for IUGR and major placenta praevia. During her second caesarean, difficulty was encountered during intubation, where anaesthetists were able to obtain a view using the CMAC D-blade but difficulty feeding the endotracheal tube. She was seen at a tertiary hospital obstetric anaesthesia high risk clinic and both general anaesthesia (GA) and epidural options discussed. An MRI of her lumbosacral spine showed a low tethered cord, with the lowest margin of the cord at the mid-S2 level. On the day of surgery an epidural technique was agreed upon by the patient and anaesthetic team, after informed consent was obtained. After preparing the patient's back with antiseptic wash, and local anaesthesia was applied to skin, an 18gauge Touhy needle was used to locate the epidural space using a loss of resistance to saline technique. After single pass, the space was located at 5.5cm, and the catheter fed and secured. After negative aspiration of cerebrospinal fluid or blood was confirmed, a test dose of 0.2% Ropivacaine was injected via an epidural filter. Further increments of 5mL of 0.2% Ropivacaine + 2mcg/mL Fentanyl was used until adequate block was obtained to the T4 dermatome. A total of 15mL of solution provided adequate anaesthesia. Surgery was completed with no associated complications. Discussion(s): Spina bifida occulta is the most common neural tube defect, with an incidence of roughly 20%, and often is an incidental finding. Features of the disease that can impact ou

Background. Сaudal epidural blocks — minimally invasive method of treating pain syndromes of the low back through the introduction of drugs into the epidural space through hiatus sacralis. The purpose of the study was to analyze the results of the treatment for pain syndromes of lumbosacral spine in its degenerative-dystrophic diseases by сaudal epidural blocks. Materials and methods. Retrospective analysis was performed in 49 patients (23 men and 26 women) aged 55.4 ± 2.1 years with complaints of low back pain, who were treated by сaudal epidural blocks. Group 1 — 27 persons with protrusions or herniated discs. Group 2 — 22 patients with lumbar spinal stenosis. The period of observation was at least 3 months after the procedure. Evaluation of treatment results was carried out by Visual analogue scale for pain assessment, Roland-Morris indices of the quality of life and Oswestry Disability Index (ODI). The number of the procedures performed was 1–3. Results. In group 1, it was marked a persistent regression of pain syndrome from 7.07 ± 1.10 cm to 3.29 ± 1.29 cm after treatment, 4.02 ± 1.64 cm — in 1 month, 4.07 ± 1.81 cm — in 3 months (p < 0.05). In group 2, we observed less pronounced and lasting regression of pain syndrome, from 7.18 ± 1.29 cm to 3.50 ± 1.33 cm after the procedure, 3.86 ± 1.72 cm — in 1 month, 4.18 ± 2.03 cm — in 3 months (p < 0.05). Regression of pain syndrome is also strongly correlated with Roland-Morris indices of the quality of life and ODI. Conclusions. Сaudal epidural block is an effective treatment of low back pain with hernias and protrusions of intervertebral discs, as well as lumbar spinal stenosis. Regression of pain correlated with improvement of quality of life according to the Roland-Morris disability questionnaires and ODI at all stages of monitoring., Актуальность. Каудальная эпидуральная блокада (КЭБ) — малоинвазивный метод лечения болевых синдромов пояснично-крестцового отдела позвоночника путем введения лекарственных препаратов в эпидуральное пространство через hiatus sacralis. Цель. Провести анализ результатов лечения болевого синдрома пояснично-крестцового отдела позвоночника на фоне его дегенеративно-дистрофических заболеваний методом КЭБ. Материалы и методы. Ретроспективный анализ результатов лечения 49 пациентов (23 мужчины и 26 женщин) в возрасте 55,4 ± 2,1 года с жалобами на боли в пояснично-крестцовом отделе позвоночника на фоне его дегенеративно-дистрофических заболеваний методом КЭБ. Группа 1 — 27 пациентов с протрузиями или грыжами межпозвоночных дисков. Группа 2 — 22 пациента с поясничным спинальным стенозом. Сроки наблюдения составили не менее 3 мес. после процедуры. Оценку результатов лечения проводили по визуальной аналоговой шкале (ВАШ) боли и индексам оценки качества жизни Роланда-Морриса и Освестри (Oswestry Disability Index, ODI). Количество проведенных процедур — 1–3. Результаты. В группе 1 отмечали стойкое регрессирование болевого синдрома с 7,07 ± 1,10 до 3,29 ± 1,29 см после процедуры, 4,02 ± 1,64 см — через 1 мес., 4,07 ± 1,81 см — через 3 мес. (p < 0,05). В группе 2 отмечалось менее выраженное и менее стойкое регрессирование болевого синдрома с 7,18 ± 1,29 до 3,50 ± 1,33 см после процедуры, 3,86 ± 1,72 см — через 1 мес., 4,18 ± 2,03 см — через 3 мес. (p < 0,05). Показатели регрессирования болевого синдрома сильно коррелировали с показателями оценки качества жизни по шкале Роланда-Морриса и Освестри. Выводы. КЭБ является эффективным методом лечения болевого синдрома пояснично-крестцового отдела позвоночника при грыжах и протрузиях межпозвоночных дисков, а также поясничном спинальном стенозе. Регрессирование болевого синдрома согласно показателям ВАШ коррелировало с улучшением качества жизни по данным опросников Роланда-Морриса и Освестри на всех этапах наблюдения., Актуальність. Каудальна епідуральна блокада (КЕБ) — малоінвазивний метод лікування больових синдромів попереково-крижового відділу хребта шляхом введення лікарських препаратів в епідуральний простір через hiatus sacralis. Мета. Провести аналіз результатів лікування больового синдрому попереково-крижового відділу хребта на тлі його дегенеративно-дистрофічних захворювань методом КЕБ. Матеріали та методи. Ретроспективний аналіз результатів лікування 49 пацієнтів (23 чоловіки і 26 жінок) віком 55,4 ± 2,1 року зі скаргами на болі в попереково-крижовому відділі хребта на тлі його дегенеративно-дистрофічних захворювань методом КЕБ. Група 1 — 27 пацієнтів із протрузіями або грижами міжхребцевих дисків. Група 2 — 22 пацієнти з поперековим спінальним стенозом. Терміни спостереження становили не менше 3 міс. після процедури. Оцінку результатів лікування проводили за показниками візуальної аналогової шкали (ВАШ) болю й індексами оцінки якості життя Роланда-Морріса та Освестрі (Oswestry Disability Index, ODI).Кількість проведених процедур — 1–3. Результати. У групі 1 відзначали стійке регресування больового синдрому з 7,07 ± 1,10 до 3,29 ± 1,29 см після процедури, 4,02 ± 1,64 — через 1 міс., 4,07 ± 1,81 см — через 3 міс. (р < 0,05). У групі 2 відзначалось менш виражене і менш стійке регресування больового синдрому з 7,18 ± 1,29 до 3,50 ± 1,33 см після процедури, 3,86 ± 1,72 см — через 1 міс., 4,18 ± 2,03 см — через 3 міс. (р < 0,05). Показники регресування больового синдрому сильно корелювали з показниками оцінки якості життя за шкалами Роланда — Морріса та Освестрі. Висновки. КЕБ є ефективним методом лікування больового синдрому попереково-крижового відділу хребта при грижах і протрузіях міжхребцевих дисків, а також поперековому спінальному стенозі. Регресування больового синдрому за ВАШ корелювало з показниками поліпшення якості життя за даними опитувальників Роланда-Морріса та Освестрі на всіх етапах спостереження.

At least 10% of patients with cancer have pain that is refractory to systemic analgesics. For most of these patients, interventional techniques may be of benefit but are often not considered or are difficult to access. Of these techniques, spinal analgesia is most commonly used in Australia and the United Kingdom, and neurosurgical procedures, such as open cordotomy with sectioning of the spinothalamic tract, are rarely used. We describe a case illustrating the successful use of bilateral open thoracic cordotomy in a patient with refractory mixed nociceptive and neuropathic pain secondary to a lumbosacral tumor. We discuss the various interventional options and review the recent literature regarding the use of both percutaneous and open cordotomy for cancer pain. © 2010 U.S. Cancer Pain Relief Committee.

At least 10% of patients with cancer have pain that is refractory to systemic analgesics. For most of these patients, interventional techniques may be of benefit but are often not considered or are difficult to access. Of these techniques, spinal analgesia is most commonly used in Australia and the United Kingdom, and neurosurgical procedures, such as open cordotomy with sectioning of the spinothalamic tract, are rarely used. We describe a case illustrating the successful use of bilateral open thoracic cordotomy in a patient with refractory mixed nociceptive and neuropathic pain secondary to a lumbosacral tumor. We discuss the various interventional options and review the recent literature regarding the use of both percutaneous and open cordotomy for cancer pain. © 2010 U.S. Cancer Pain Relief Committee.