Clinical case of combined two-level spinal-epidural anesthesia with fixation of an epidural catheter in the subcutaneous canal with removal to the anterior abdominal wall

Abstract

We present an example of a combined two-level spinal-epidural anesthesia with fixation of an epidural catheter in the subcutaneous canal and its removal to the anterior abdominal wall in an 80-year-old patient during surgical treatment of a closed pertrochanteric fracture of the left femur with fragment displacement. After preoperative preparation and examination, the patient underwent surgery: Open reposition of a comminuted pertrochanteric fracture of the left femur, osteosynthesis with a dynamic femoral screw. Anesthesiological pro-vision of surgical intervention: combined two-level spinal-epidural anesthesia with a method developed in our clinic for fixing an epidural catheter in the subcutaneous canal using a modified spinal needle and bringing the catheter to the anterior abdominal wall. After the operation, the patient underwent postoperative analgesia in the form of prolonged epidural analgesia for 96 hours. The postoperative period passed without complications. On the 12th day, the patient was discharged for outpatient treatment by a traumatologist. The use of neuraxial methods of anesthesia in an elderly patient with a high anesthetic risk in the surgical treatment of a fracture of the proximal femur with postoperative analgesia in the form of prolonged epidural analgesia, in which the epidural catheter was tunneled under the skin of the lumbar region and brought to the anterior abdominal wall, contributed to the successful implementation of surgery, early activation and verticalization of the patient, the absence of complications in the postoperative period. A new method of fixing the catheter in the subcutaneous canal with its removal to the anterior abdominal wall made it possible to prevent dislocation of the epidural catheter.