THORACIC SPINAL ANAESTHESIA IN A PARTURIENT WITH EXTENSIVE MID- TO LOWER-BACK TINEA CORPORIS UNDERGOING ELECTIVE CAESAREAN SECTION: A CASE REPORT

Abstract

Background: Active cutaneous infection overlying the conventional lumbar puncture site is regarded as a relative contraindication to neuraxial anaesthesia because of the theoretical risk of introducing microorganisms into the epidural or subarachnoid space. Extensive dermatophytosis affecting the lower thoracic and lumbar region therefore poses a distinct challenge during elective caesarean section, where neuraxial anaesthesia remains the preferred modality. Thoracic spinal anaesthesia has been proposed as a safe alternative in such circumstances when performed with careful patient selection and meticulous technique. Case Presentation: We describe the anaesthetic management of a 25-year-old gravida 2 para 1 living 1 woman at 38 weeks and 4 days of gestation, with gestational hypertension and a previous lower segment caesarean section, admitted for elective repeat caesarean delivery. Extensive active tinea corporis involved the lower thoracic, lumbar, gluteal, right hip, thigh, and leg regions, with erythematous scaly plaques extending across the intended lumbar puncture site; conventional lumbar spinal anaesthesia was therefore avoided. After multidisciplinary discussion and informed high-risk consent, thoracic subarachnoid block was performed at the T10–T11 interspace in the sitting position using a 25-gauge Quincke needle, with 2 mL of 0.5% hyperbaric bupivacaine and fentanyl 25 µg injected intrathecally over an uninvolved area of skin. Surgical sensory blockade developed within 1 minute 28 seconds, and intraoperative haemodynamics remained stable, requiring only a single dose of intravenous ephedrine. A healthy male infant weighing 2.8 kg was delivered with Apgar scores of 9 and 9 at one and five minutes. The perioperative course was uneventful, with no post dural puncture headache, neurological deficit, or infective complication; the patient was discharged on postoperative day 3. Conclusion: Thoracic spinal anaesthesia is a feasible and effective alternative neuraxial technique in carefully selected obstetric patients in whom conventional lumbar puncture is precluded by extensive lumbar dermatophytosis. Rigorous preoperative evaluation, strict asepsis, sound knowledge of thoracic spinal anatomy, and vigilant perioperative monitoring are essential prerequisites for a safe maternal and neonatal outcome.