LAUSR

A 14-year-old, hearing impaired boy, whose weight was 37 kg, presented to the orthopaedic department with the complaint of left lower limb deformity since birth. A diagnosis of congenital talipes equinovarus of left foot was made. The right foot was normal. He was scheduled for a closing wedge osteotomy. He had undergone uneventful anaesthesia for cochlear implant surgery at the age of 3 years. The rest of his pre-anaesthetic evaluation was normal. General anaesthesia along with insertion of epidural catheter for perioperative analgesia was planned. General anaesthesia was induced with injection fentanyl 80 μg plus injection propofol 50 mg given intravenously. An i-gel size 3 was then inserted and anaesthesia was maintained using oxygen in air and sevoflurane. Under anaesthesia, a 20 G Tuohy needle was inserted at L3–L4 level in the lateral decubitus position in a single attempt with all asepsis (2% chlorhexidine with 70% alcohol). After confirmation of loss of resistance (using air), the epidural catheter was inserted in a single attempt and fixed at 7 cm from the skin (2.5 cm was depth of epidural from skin and 4.5 cm was left in situ). After a negative test dose, 3 ml of injection bupivacaine (0.25%) was given through the epidural catheter, followed by a bupivacaine infusion (0.125%) at the rate of 5 ml per hour. The surgery was conducted in the supine position, was uneventful, and lasted about 90 min. After the patient regained consciousness, the i-gel was removed. The patient was comfortable with no pain at the surgical site. The next morning, he complained of numbness in his contralateral (right) foot. There was some sensory deficit, but the patient was responsive to pain and no motor deficit was present. The epidural infusion was stopped and the catheter was removed. However, the motor power started reducing gradually in the limb, the ankle jerk was absent, and the patient developed a foot drop after 48 h.