Achondroplasia is the commonest form of short-limbed
dwarfism and occurs in 1:26,000-40,000 live births. This is an autosomal dominant disorder with abnormal endochondral ossification whereas periosteal and intramembranous ossification are normal. The basic abnormality is a disturbance of cartilage formation mainly at the epiphyseal growth plates and at the base of the skull. The
anesthetic management of achondroplastic dwarfs is a challenge to the anesthesiologist. Both regional as well as
general anesthesia have their individual risks and consequences. We report a case of an achondroplastic dwarf in whom combined spinal
epidural anesthesia was used for fixation of a fractured femur. The patient had undergone previous femur surgery under
general anesthesia since he had been informed that
spinal anesthesia could be very problematic. There was no technical difficulty encountered during the procedure and an adequate level was achieved with low-dose
local anesthetics without any problem.
Postoperative pain relief was offered for three consecutive postoperative days using epidural
tramadol. We discuss the
anesthetic issues and highlight the role of combined spinal
epidural anesthesia with low-dose
local anesthetics in this patient. This approach also helped in
early ambulation and
postoperative pain relief.