Successful ultrasound-guided epidural anaesthesia following failed spinal anaesthesia in a patient with neurofibromatosis 1

Abstract

Neurofibromatosis type 1 (NF1) is a genetic disorder characterised by neurofibromas and skeletal anomalies, including lumbar kyphoscoliosis and dysmorphic sacral vertebrae. We report a rare case of a male in his late 30s with NF1 presenting with a left-sided hip dislocation and an unusual response to spinal anaesthesia. Spinal anaesthesia was attempted using 3 mL of 0.5% hyperbaric bupivacaine (dextrose 8%), resulting in a unilateral block. Pulmonary function tests did not favour general anaesthesia; hence, an MRI was performed that showed extensive abnormalities in the spine. The next day, ultrasound-guided epidural anaesthesia at T10-T11 was performed successfully with placement of an epidural catheter in situ for postoperative pain control. This is a rare phenomenon underlining the complexity of anaesthetic management in patients with NF1 and significant spinal abnormalities.

Keywords: Anaesthesia; Musculoskeletal and joint disorders.