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Do you guys routinely attempt spinal or epidurals in patients with preexisting lumbar fusions?
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Spinals all the time. Then I thank the surgeon later for marking midline for me.Do you guys routinely attempt spinal or epidurals in patients with preexisting lumbar fusions?
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Spinals all the time. Then I thank the surgeon later for marking midline for me.
Epidurals can be dicey as the space can be destroyed during the fusion. I usually avoid that level and warn the patient is a potential patchy block.
Most of the time I'll recommend/choose GA because these patients tend to have issues with back pain postoperatively.
These patients have likely had decades of back pain and you are pretty unlikely to get blamed for that postop.
+10. I had parturients vehemently refuse neuraxial blocks because their families were convinced that they were a source of chronic back pain. My current malpractice risks are low, and still I tend to avoid placing blocks (including PNBs) whenever there is some kind of pre-existing disease. Some patients are just uneducated/-able, and all the science in the world can't beat the faith in their own stupidity. Some believe that bad things happens only because of bad doctors.Ignorance among the lay population is very high and a small % of them will absolutely "blame" your SAB for the back problems:
Spinal anaesthesia | February 2002 (Vol. 12 Issue 11) | Magazine | What Doctors Don't Tell You
Please don't misunderstand my posts on this issue; I'm completely in favor of SAB as the technique of choice for many procedures. But, the patient's attitude and understanding of the anesthetic choice does play a role.