Background: Anesthesia management for patients with severe ankylosing spondylitis scheduled for total hip arthroplasty\nis challenging due to a potential difficult airway and difficult neuraxial block. We report 4 cases with ankylosing spondylitis\nsuccessfully managed with a combination of lumbar plexus, sacral plexus and T12 paravertebral block.\nCase presentation: Four patients were scheduled for total hip arthroplasty. All of them were diagnosed as severe\nankylosing spondylitis with rigidity and immobilization of cervical and lumbar spine and hip joints. A combination of T12\nparavertebral block, lumbar plexus and sacral plexus block was successfully used for the surgery without any additional\nintravenous anesthetic or local anesthetics infiltration to the incision, and none of the patients complained of discomfort\nduring the operations.\nConclusions: The combination of T12 paravertebral block, lumbar plexus and sacral plexus block, which may block all\nnerves innervating the articular capsule, surrounding muscles and the skin involved in total hip arthroplasty, might be a\npromising alternative for total hip arthroplasty in ankylosing spondylitis.
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