Key result
Spinal anaesthesia using a 5-inch needle was administered in a superobese patient with necrotizing fasciitis, overcoming challenges of deep nerve location and local skin infection.
Why the study?
A BMI ≥50 kg m requires optimum anaesthetic expertise during the perioperative period, presenting unique challenges in patients with multiple comorbidities.
Case Report (n=1)
Answers are grounded in this paper and cite their sources.
Highlights the technical challenges and successful use of spinal anaesthesia with a 5-inch needle in a super obese patient with necrotizing fasciitis and acute kidney injury.
The fast paced lifestyle with no control over diet and lack of exercise has led to rapid rise in obesity in worldwide population. India being a developing country is no exception to this. A body mass index (BMI) ≥50 kg m, referred to as super obese necessitates optimum anaesthetic expertise during perioperative period. We faced a conundrum of challenges while managing a case of necrotizing fascitis in a superobese patient with multiple comorbidities. Peripheral nerve block was an ideal technique for this patient but for local site skin infection and deep nerve location, spinal anaesthesia with 5 inch (12.7 cm) spinal needle was administered. Regional anaesthesia in obese patients comes with a lot of difficulties including localizing the intervertebral space, narrow subarachnoid space, increased pressure, positioning the patient. Restricted fluid intake due to acute kidney injury leading to decreased preload compounds the above factors.
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K et al. (2023) conducted a case report in Necrotizing fasciitis in super obesity (n=1). Spinal anaesthesia with 5 inch (12.7 cm) spinal needle was evaluated. Spinal anaesthesia using a 5-inch needle was administered in a superobese patient with necrotizing fasciitis, overcoming challenges of deep nerve location and local skin infection.
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