{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T01:20:24Z","timestamp":1770686424684,"version":"3.49.0"},"reference-count":6,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,3,19]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:p>A woman in her mid-50s, hesitant about general anaesthesia due to a difficult airway, opted for neuraxial anaesthesia for L4 laminectomy with pedicle screw fixation (L3\u2013L5). Preoperatively, she received 150\u2009\u00b5g buprenorphine and 1\u2009mg midazolam. In lateral position, a T8\u2013T9 epidural catheter was placed, followed by segmental spinal anaesthesia (2.5\u2009mL 0.5% hyperbaric bupivacaine+30\u2009\u00b5g clonidine) at T10\u2013T11. Prone positioning was executed using standard techniques. During the 6\u20137\u2009hours surgery, three 7\u2009mL epidural top-ups (2% lignocaine epinephrine) were administered at 90\u2009min intervals. Haemodynamics remained stable with 2.5 L crystalloids, 350\u2009mL packed red cells and three ephedrine doses (6\u2009mg each). Sedation included 150\u2009\u00b5g buprenorphine and two 1\u2009mg midazolam doses. Postoperatively, she received epidural 0.25% bupivacaine for 2\u2009days, systemic analgesics and was discharged on the sixth day.<\/jats:p>","DOI":"10.1136\/bcr-2023-257734","type":"journal-article","created":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T08:35:48Z","timestamp":1711701348000},"page":"e257734","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Combined segmental spinal epidural for major spine surgery: a case report"],"prefix":"10.1136","volume":"17","author":[{"given":"Srinivasan","family":"Parthasarathy","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jawadh","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Sri Balaji Vidyapeeth University, Pondicherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,3,29]]},"reference":[{"key":"2025082800513080000_17.3.e257734.1","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.jcot.2020.05.005","article-title":"Anesthetic considerations in spine surgery: what Orthopaedic surgeon should know","volume":"11","author":"Khanna","year":"2020","journal-title":"J Clin Orthop Trauma"},{"key":"2025082800513080000_17.3.e257734.2","doi-asserted-by":"crossref","first-page":"733","DOI":"10.14245\/ns.2142584.292","article-title":"Regional anesthesia for lumbar spine surgery: can it be a standard in the future? 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