Ultrasound-Guided Neuraxial Block in Difficult Patients

This case report documents the experiences of ultrasound-guided neuraxial block in two challenging patients: one morbidly obese adult and one pediatric patient with severe scoliosis. The report outlines the difficulties associated with traditional intrathecal injection techniques, particularly in patients with obesity or spinal deformities, which can complicate the identification of anatomical landmarks. The first case involves a 37-year-old male with a BMI of 56.5 who required spinal anesthesia for an endoscopic ureteral stone operation. The use of ultrasonography allowed for accurate identification of the L3–4 interspace, facilitating a successful single-puncture approach. The second case describes a 12-year-old patient with scoliosis who was unable to receive intrathecal nusinersen treatment due to anatomical challenges. The report emphasizes the advantages of using ultrasound in such cases to improve the success rate of neuraxial procedures while minimizing complications. The findings suggest that ultrasound can enhance procedural success in patients with difficult anatomical landmarks.