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Combined segmental spinal epidural for major spine surgery: a case report
  1. Srinivasan Parthasarathy1 and
  2. Jawadh Hussain2
  1. 1Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
  2. 2Department of Anaesthesia, Sri Balaji Vidyapeeth University, Pondicherry, India
  1. Correspondence to Dr Srinivasan Parthasarathy; painfreepartha{at}


A woman in her mid-50s, hesitant about general anaesthesia due to a difficult airway, opted for neuraxial anaesthesia for L4 laminectomy with pedicle screw fixation (L3–L5). Preoperatively, she received 150 µg buprenorphine and 1 mg midazolam. In lateral position, a T8–T9 epidural catheter was placed, followed by segmental spinal anaesthesia (2.5 mL 0.5% hyperbaric bupivacaine+30 µg clonidine) at T10–T11. Prone positioning was executed using standard techniques. During the 6–7 hours surgery, three 7 mL epidural top-ups (2% lignocaine epinephrine) were administered at 90 min intervals. Haemodynamics remained stable with 2.5 L crystalloids, 350 mL packed red cells and three ephedrine doses (6 mg each). Sedation included 150 µg buprenorphine and two 1 mg midazolam doses. Postoperatively, she received epidural 0.25% bupivacaine for 2 days, systemic analgesics and was discharged on the sixth day.

  • orthopaedics
  • anaesthesia

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigations results, drawing original diagrams and algorithms, and critical; revision of the intellectual content: PS and JH. The following authors gave final approval of the manuscript. PS and JH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.