Abstract
We illustrate repeat dosing of spinal anesthesia as a means to avoid opioids during lumbar surgery for a patient intolerant of opioids. A patient required redo lumbar surgery but had a marked history of nausea, vomiting and retching in response to opioids. A propofol-based anesthetic was supplemented with intravenous ketamine and intrathecal bupivacaine. The first dose of bupivacaine receded during the lengthy surgical procedure but was supplemented by means of a 25-gauge pencil-point needle passed through the exposed dura. Postoperatively, there was no spinal fluid leak, no headache, and no nausea. Supplementation of intrathecal anesthesia under direct dural vision during lengthy lumbar surgery is facile, can help to obviate a need for opioids, and can aid in avoidance of postoperative nausea and vomiting.
Highlights
“One-shot” regional anesthesia has been used for spine surgery [1,2,3,4,5,6], and epidural catheters have been employed either intraoperatively or postoperatively [7,8,9,10,11]
Compared to a regional anesthesia group, severe nausea was more common in the general anesthesia group in the PACU and during the 24 h after surgery [3]
Total intravenous anesthesia combined with multiple antiemetic medications is the preferred anesthetic as a means to eliminate the inhalation anesthetic component of the risk factors for postoperative nausea and vomiting (PONV) [15]
Summary
Because of history of severe postoperative nausea and vomiting (PONV), she requested the analgesia plan to lack opiates. We successfully applied a combination of intravenous general and intrathecal anesthesia. A repeat dose of intrathecal bupivacaine was indicated intraoperatively, and this was achieved via the surgical wound. “One-shot” regional anesthesia has been used for spine surgery [1,2,3,4,5,6], and epidural catheters have been employed either intraoperatively or postoperatively [7,8,9,10,11]. The useful option of re-dosing spinal anesthesia intraoperatively by means of needles passed via lumbar surgical wounds has not been previously described
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