The use of lumbar X-rays to facilitate neuraxial anaesthesia during knee replacement surgery in patients who have had previous spinal surgery

Abstract

Background: Knee replacement surgery is an operation that is performed on older patients, with a few exceptions. Many of these patients have co-existing diseases and have had previous surgery, of which lumbar spinal surgery is of particular relevance. Neuraxial anaesthesia is the anaesthetic of choice. Method: This study offers a practical approach to how anterioposterior and lateral X-rays of the lumbar spine contribute to the ease and safety of the neuraxial anaesthesia procedure. The study group comprised 100 patients, scheduled for knee replacement surgery. The patients had to have undergone previous lumbar spinal surgery. This was the only prerequisite. Results: The success rate of neuraxial anaesthesia improved progressively during the study. It became clear that specific clinical aspects had potential for future application in this particular group of patients. Only four of a total of 23 combined spinal epidural procedures were not successful. There were three dural taps without any post-dural puncture headaches being experienced. Spinal blocks totalled 77, of which two were incomplete and five complete failures. Conclusion: Calculated performance of neuraxial anaesthesia on patients who had undergone previous lumbar spinal surgery set the scene for a more predictable and largely atraumatic outcome.