{
  "abstract": "Background and Aims Alkaptonuria (AKU), otherwise known as ‘black bone disease’, is a rare autosomal recessive metabolic disorder resulting in the accumulation of homogentisic acid in connective tissues. Consequently, valvular abnormalities and degeneration of large weight-baring joints such as the hips, knees and spine are seen. There are very few case-reports available in the literature regarding spinal anaesthesia in this group, particularly in the context of also having undergone spinal instrumentation surgery.Methods We present the case of a 71-year-old lady who had an elective total hip replacement under spinal anaesthesia despite previous extensive spinal instrumentation (T10-S1) and alkaptonuria. Pre-procedural ultrasound resulted in the accurate identification of an inter-spinous space at L1/L2, first pass injection and normal spread of local anaesthetic. Ultrasound avoided multiple unsuccessful attempts at lower inaccessible levels due to scar tissue and degenerative changes.Results Successful ultrasound-guided single attempt spinal anaesthesia for a hip replacement surgery for a patient with alkaptonuria who also had a spinal fusion surgery (T10-S1)Abstract P024 Figure 1Lumbar spine - fusedConclusions In our experience, alkaptonuria and previous posterior spinal instrumentation do not preclude successful spinal anaesthesia despite perceived difficulties. Careful review of old op-notes and radiological imaging is important in planning for neuraxial anaesthesia. More formal training in spinal ultrasound techniques for anaesthetists will likely increase the number of patients who could benefit from spinal anaesthesia following spinal instrumentation or other pre-existing spinal pathology.",
  "authors": [
    {
      "affiliations": [
        "Anaesthesia, WWL NHS Trust, Wigan, UK"
      ],
      "name": "Haritha Karnati"
    },
    {
      "affiliations": [
        "Anaesthesia, Manchester Royal Infirmary, Manchester, UK"
      ],
      "name": "Lauren Mcgarey"
    },
    {
      "affiliations": [
        "Anaesthesia, WWL NHS Trust, Wigan, UK"
      ],
      "name": "Mruthunjaya Hulgur"
    }
  ],
  "title": "P024 Regional anaesthesia for total hip replacement in a patient with alkaptoinuria and spinal fusion",
  "uid": "4131abd3-2277-50e3-a821-671067d56f03"
}