Rationale: Sacrococcygeal pilonidal disease (SPD) is a chronic inflammatory condition primarily affecting young males. This case report details the perioperative anesthetic management of a patient undergoing SPD surgery under subarachnoid anesthesia.
Patient concerns: A 48-year-old obese male (body mass index 28 kg/m2) presented with recurrent sacrococcygeal swelling, pain, and purulent discharge for 2 months. Magnetic resonance imaging revealed a pilonidal sinus in the left subcutaneous sacrococcygeal region, with additional findings of degenerative vertebral changes and left paracentral disc protrusion at the fourth or fifth lumbar vertebrae.
Diagnoses: SPD with abscess formation.
Interventions: Following comprehensive evaluation, the patient underwent SPD excision under subarachnoid anesthesia. Lumbar puncture was performed at the third and fourth lumbar vertebrae interspace, and 2 mL of 0.6% ropivacaine was administered, achieving a sensory block up to the eighth thoracic vertebra level. The patient experienced transient respiratory difficulty during positional change from supine to prone, necessitating immediate reassessment of the block level and appropriate management. Vital signs were closely monitored intraoperatively, with meticulous postoperative follow-up.
Outcomes: The surgery was completed successful with stable hemodynamics. No significant anesthesia-related complications were observed within 24 hours postoperatively.
Lessons: Thorough preoperative assessment of local and systemic infection status is essential in SPD patients undergoing subarachnoid anesthesia. Intraoperative positional changes may affect the level of subarachnoid block, requiring vigilant monitoring of vital signs and respiratory function. Postoperative care should focus on potential anesthetic complications and wound care requirements. Individualized anesthetic management strategies are crucial for ensuring patient safety.
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