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Background: Subarachnoid block in patients with scoliosis always present a unique challenge to the anesthesiologist owing to the deformity of spine. Difficulty in performing neuraxial anaesthesia may result in neural injury, spinal haematoma, post-dural puncture headache In addition, it may decrease procedure efficiency and increase patient discomfort and dissatisfaction. The most commonly practiced technique is the midline approach. This approach is technically difficult in the geriatric patients because of degenerative changes in the spine. Calcification of supraspinous and interspinous ligaments in the geriatric age group makes midline approach difficult. Paramedian approach and its modification Taylor’s approach is not routinely practiced and is definitely a game changer when midline approach of lumbar subarachnoid block has failed or is not possible due to anatomical variations like ankylosing spondylitis, thoracolumbar kyphoscoliosis. We report a case of unilateral hemiparesis patient with severe thoracolumbar scoliosis anaesthetically managed by Taylor’s approach of lumbar Subarachnoid block for Proximal Femur Nailing (PFN) of intertrochanteric fracture thus avoiding general anaesthesia and associated aerosol generation in the era of COVID19 pandemic.

annals of anesthesia and pain medicine

Anaesthetic Management of Hemiparesis Patient with Severe Thoracolumbar Scoliosis for Orthopaedic Surgery by Taylor ‘s Approach of Lumbar Subarachnoid Block in the era of COVID 19 Pandemic