Epidural Anesthesia in a Patient with Severe Thoracic Kyphosis Undergoing Primary Cesarean Delivery: A Case Report

The administration of neuraxial anesthesia among parturient patients with concomitant spine deformity poses challenges to anesthesiologists. The apprehension stems from the increased possibility of a failed block and complications arising from potential neurologic injury due to anatomic variance. This is a case report of a 30-year old female gravida 1 para 0 at 36 4/7 weeks age of gestation with severe thoracic kyphosis who underwent emergency primary low segment cesarean section under epidural anesthesia. Ultrasonography of the spine was done pre-induction to visualize spinal anatomy and verify anatomic landmarks. Epidural anesthesia was attempted twice before achieving adequate block to dermatomal level T4 within approximately seven minutes. The patient was able to tolerate the procedure well without significant intraoperative events. Fetal outcomes were also favorable with APGAR scores of 9,9. This case report emphasizes that with extensive preoperative evaluation and preparation, an individualized anesthetic plan may be devised. Ultrasound-guided epidural catheter insertion can be a safe option for obstetric patients with thoracic kyphosis.