Double neuraxial catheter (Subarachnoid and epidural) in obese patient cancer surgery: A case report

INTRODUCTION: Morbid obesity is one of the major concerns when performing surgeries, due to higher risks of anesthetic complications. Combined spinal and epidural (CSE) anesthesia technique is used effectively in variety of surgical procedures. CASE PRESENTATION: Our patient is a 58-year old female with a Body Mass Index (BMI) of 44.53 who presented to the emergency department complaining of an abdominal pain of a renal nature. She was found to have an abdominal mass suggestive of anexial mass or a Gastro Intestinal Stromal Tumor (GIST) and was scheduled for surgery. Due to the risks associated with general anesthesia, a double neuraxial catheter (subarachnoid and epidural) was the anesthitic method of choice. DISCUSSION: Overweight and obesity represent a rapidly growing threat to the health of populations in an increasing number of countries. The first report using the double catheter technique described a parturient with a BMI of 76 kg/m2 who had a lumbar Combined Spinal Epidural (CSE) catheter placed for intraoperative anesthesia and postoperative pain management. In the published literature CSE technique use is limited to obstetric procedure of obese females. CONCLUSION: In our case it is highlighted how an obese patient, with severe comorbidities that can jeopardize the success of the treatments, can be discharged in a few days by performing an “unconventional” but effective anesthetic technique.