EPIDURAL-ANESTHESIA FOR EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY IN AN ACHONDROPLASTIC DWARF

Background and Objectives. A 66-year-old achondroplastic male dwarf wi th right ureteral stones presented for outpatient extracorporeal shock wave lithotripsy under epidural anesthesia. Methods. The patient had marked lumbar lordosis and mild thoracic kyphosis. Although the epidur al space was located easily at the L2-3 interspace on the first attemp t, the catheter could not be advanced beyond the Tuohy needle. On the second attempt, the epidural space was located easily at the L1-2 inte rspace, and the catheter was advanced without difficulty. Results. A s ensory block to the T2 level developed after administration of 2 mt of lidocaine 1.5% with epinephrine 1:200,000 and 9 mt of lidocaine 2.0% with epinephrine 1:200,000. Aside from a short period of mild, asympto matic hypotension, the patient's intraoperative and postoperative cour ses were unremarkable. Conclusions. This case report and the available literature support the feasibility of epidural anesthesia in achondro plastic patients. Careful titration of the local anesthetic dose is re commended since achondroplastic patients may have extensive spread of epidural anesthesia.