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Erector Spinae Plane Block with Ultrasound- and CT-Based Double-Lumen Tube Selection for Thoracotomy in Giant Pulmonary Hydatid Cyst: A Case Report

December 10, 2025/1 Comment/in Volume 6; Issue 2: July-December 2025/by Ijraijraadmin

Vol 6 | Issue 2 | July-December 2025 | Page 20-22 | Nazia Nazir, Bhumika Gautam, Shivi Mishra, Samiksha Khanuja, Savita Gupta DOI: https://doi.org/10.13107/ijra.2025.v06.i02.138 Open Access License: CC BY-NC 4.0 Copyright Statement: Copyright © 2025; The Author(s). Submitted: 20-07-2025; Reviewed: 15-08-2025; Accepted: 17-10-2024; Published: 10-12-2025 Authors: Nazia Nazir [1], Bhumika Gautam [1], Shivi Mishra [1], […]

Spinal Anaesthesia for Inguinal Herniotomy in an Infant with Mucopolysaccharidosis type III with skeletal dwarfism: A Case Report

December 10, 2025/1 Comment/in Volume 6; Issue 2: July-December 2025/by Ijraijraadmin

Vol 6 | Issue 2 | July-December 2025 | Page 16-19 | Sreyashi Naskar , K R Chandrakala , Soumya Nayak DOI: https://doi.org/10.13107/ijra.2025.v06.i02.136 Open Access License: CC BY-NC 4.0 Copyright Statement: Copyright © 2025; The Author(s). Submitted: 01-06-2025; Reviewed: 29-06-2025; Accepted: 13-11-2025; Published: 10-12-2025 Authors: Sreyashi Naskar [1], K R Chandrakala [1], Soumya Nayak [1] […]

Erector Spinae Plane Block with Ultrasound- and CT-Based Double-Lumen Tube Selection for Thoracotomy in Giant Pulmonary Hydatid Cyst: A Case Report

December 10, 2025/1 Comment/in Volume 6; Issue 2: July-December 2025/by Ijraijraadmin

Spinal Anaesthesia for Inguinal Herniotomy in an Infant with Mucopolysaccharidosis type III with skeletal dwarfism: A Case Report

December 10, 2025/1 Comment/in Volume 6; Issue 2: July-December 2025/by Ijraijraadmin

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Erector Spinae Plane Block with Ultrasound- and CT-Based Double-Lumen Tube Selection for Thoracotomy in Giant Pulmonary Hydatid Cyst: A Case Report

December 10, 2025/1 Comment/in Volume 6; Issue 2: July-December 2025/by Ijraijraadmin

Vol 6 | Issue 2 | July-December 2025 | Page 20-22 | Nazia Nazir, Bhumika Gautam, Shivi Mishra, Samiksha Khanuja, Savita Gupta

DOI: https://doi.org/10.13107/ijra.2025.v06.i02.138

Open Access License: CC BY-NC 4.0

Submitted: 20-07-2025; Reviewed: 15-08-2025; Accepted: 17-10-2024; Published: 10-12-2025

Authors: Nazia Nazir [1], Bhumika Gautam [1], Shivi Mishra [1], Samiksha Khanuja [1], Savita Gupta [1]

[1] Department of Anesthesiology and Critical Care Government Institute of Medical Sciences, Greater Noida, UP, India.

Address of Correspondence

Dr. Nazia Nazir,
Department of Anesthesiology and Critical CareGovernment Institute of Medical Sciences, Greater Noida, UP, India.
E-mail: nazunazir@gmail.com

Abstract

Background: Excision of giant pulmonary hydatid cysts carries high risks of cyst rupture, anaphylaxis, and respiratory compromise, necessitating precise lung isolation and robust regional analgesia.
Case Description: A 35-year-old female presented for posterolateral thoracotomy to excise a giant pulmonary hydatid cyst. The primary anesthetic goals were to ensure atraumatic lung isolation and minimize postoperative pulmonary complications.
Intervention: A multimodal approach was utilized: airway ultrasound and CT imaging were combined to precisely select a left-sided double-lumen tube (DLT). For analgesia, an ultrasound-guided erector spinae plane (ESP) block was administered preoperatively to facilitate an opioid-sparing technique.
Outcome: The strategy resulted in effective lung isolation, excellent intraoperative stability, and superior postoperative pain control. The patient was extubated early, demonstrated improved respiratory mechanics, and achieved an uneventful recovery with minimal opioid requirements.
Conclusion: Combining image-guided airway assessment with the ESP block provides a safe, effective, and comprehensive anesthetic strategy for high-risk thoracic procedures.
Keywords: Airway ultrasound, Double-lumen tube sizing, Erector spinae plane block, Thoracotomy analgesia, Pulmonary hydatid cyst, One-lung ventilation

References

1. Al-Hurani M, Al-Hadrab Y, Ayoub KR, Al-Salhi A, Al-Sarsour HS, Kocher GJ. Thoracoscopic Approach for Treating a Primary Hydatid Cyst in the Thymus in a Teenager: A Case Report. Am J Case Rep. 2025; 22;26: e948600.
2. Sachar S, Goyal S, Goyal S, Sangwan S. Uncommon locations and presentations of hydatid cyst. Ann Med Health Sci Res. 2014;4(3):447-52.
3. Pokhriyal, Abhimanyu Singh; Tomar, Sonu; Saran, Vinayak. Anesthetic management of the patient with large pulmonary hydatid cyst: A case report. Bali Journal of Anesthesiology 2024;8(1): 53-6
4. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane blocks in thoracic surgery. Anaesthesia. 2017;72(4):452–460.
5. Mathew RM, Gautam S, Raman R, Rai A, Srivastava VK, Singh MK. Evaluating the precision of ultrasound versus computed tomography-guided measurement of cricoid cartilage diameter for double-lumen tube selection in thoracic surgery: A randomised comparative study. Indian J Anaesth. 2024; 68(10):896-901.
6. Brodsky JB, Lemmens HJ. Left double-lumen tube size selection: A practical method.
Anesth Analg. 2005;100(3):853–856.
7. Pooja Chandran, Ankit Agarwal, Debendra K Tripathy, Nitish Thakur, Vikram Chandra. Anaesthetic Considerations in Simultaneous Management of Pulmonary and Hepatic Ruptured Hydatid Cyst: A Case Report. Archives of Anesthesiology and Critical Care 2023; 9(3): 265-267.
8. Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy. Ann Transl Med. 2019;7(8):174.

How to Cite this Article: Nazir N, Gautam B, Mishra S, Khanuja S, Gupta S. Erector Spinae Plane Block with Ultrasoundand CT-Based Double-Lumen Tube Selection for Thoracotomy in Giant Pulmonary Hydatid Cyst: A Case Report. International Journal of Regional Anaesthesia. July-December 2025; 6(2): 20-22. DOI: https://doi.org/10.13107/ijra.2025.v06.i02.138

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Spinal Anaesthesia for Inguinal Herniotomy in an Infant with Mucopolysaccharidosis type III with skeletal dwarfism: A Case Report

December 10, 2025/1 Comment/in Volume 6; Issue 2: July-December 2025/by Ijraijraadmin

Vol 6 | Issue 2 | July-December 2025 | Page 16-19 | Sreyashi Naskar , K R Chandrakala , Soumya Nayak

DOI: https://doi.org/10.13107/ijra.2025.v06.i02.136

Open Access License: CC BY-NC 4.0

Submitted: 01-06-2025; Reviewed: 29-06-2025; Accepted: 13-11-2025; Published: 10-12-2025

Authors: Sreyashi Naskar [1], K R Chandrakala [1], Soumya Nayak [1]

[1] Department of Paediatric Anaesthesiology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.

Address of Correspondence

Dr. Sreyashi Naskar,
Department of Paediatric Anaesthesiology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka. India
E-mail id: sreyashi.n@gmail.com

Abstract

Mucopolysaccharidosis (MPS) is an inherited lysosomal storage disorder where glycosaminoglycans accumulate in various connective tissues, resulting into a myriad of organ system abnormalities. One of the most challenging aspect of their anaesthesia management is airway control, as these are almost always deemed difficult airway subjects. Anaesthetising neonates or small infants with MPS proves to be an even more critical scenario due to their added airway and respiratory physiological characteristics. Conducting surgeries on such patients under sole regional/ neuraxial anaesthesia can be an extremely efficacious and safe approach, provided the difficulties in their neuraxial anatomy are kept in mind, and thereof, managed accordingly. However, sole neuraxial anaesthesia in small children with MPS is scantly reported in existing literature and hence needs further reporting and study.
Keywords: Mucopolysaccharidoses, Mucopolysaccharidosis III, Obstructive Sleep Apneas, Dwarfism, Airway management

References

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2. Clark BM, Sprung J, Weingarten TN, Warner ME. Anesthesia for patients with mucopolysaccharidoses: Comprehensive review of the literature with emphasis on airway management. Bosn J Basic Med Sci. 2018;18(1):1-7. Published 2018 Feb 20. doi:10.17305/bjbms.2017.2201
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4. Megens JH, de Wit M, van Hasselt PM, Boelens JJ, van der Werff DB, de Graaff JC. Perioperative complications in patients diagnosed with mucopolysaccharidosis and the impact of enzyme replacement therapy followed by hematopoietic stem cell transplantation at early age. Paediatr Anaesth. 2014;24(5):521-527. doi:10.1111/pan.12370
5. Walker R, Belani KG, Braunlin EA, et al. Anaesthesia and airway management in mucopolysaccharidosis. J Inherit Metab Dis. 2013;36(2):211-219. doi:10.1007/s10545-012-9563-1
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7. Kempthorne PM, Brown TC. Anaesthesia and the mucopolysaccharidoses: a survey of techniques and problems. Anaesth Intensive Care. 1983;11(3):203-207. doi:10.1177/0310057X8301100304
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How to Cite this Article: Naskar S, Chandrakala KR, Nayak S. Spinal Anaesthesia for Inguinal Herniotomy in an Infant with Mucopolysaccharidosis type III with skeletal dwarfism: A Case Report. International Journal of Regional Anaesthesia. July-December 2025; 6(2): 16-19. DOI: https://doi.org/10.13107/ijra.2025.v06.i02.136

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Authors: Nazia Nazir [1], Bhumika Gautam [1], Shivi Mishra [1], Samiksha Khanuja [1], Savita Gupta [1]

Authors: Sreyashi Naskar [1], K R Chandrakala [1], Soumya Nayak [1]

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