Real-time ultrasound-guided subarachnoid block for pressure ulcer repair in an elderly long-term bedridden patient with severe spinal deformity: a case report

Background Elderly long-term bedridden patients often develop pressure ulcer-induced skin and subcutaneous necrosis requiring surgical repair. Conventional landmark-guided spinal anaesthesia is challenging due to positioning limitations and spinal deformities. Ultrasound-guided techniques offer clear visualisation of spinal anatomy, improving puncture success and reducing complications. We report a case of successful real-time ultrasound-guided subarachnoid block for pressure ulcer repair in an elderly patient with severe spinal deformity, providing clinical insights for anaesthetic management. Case Presentation A 90-year-old female with American Society of Anesthesiologists (ASA) physical status grade III, long-term bed rest, and late-stage Alzheimer’s disease underwent right hip pressure ulcer repair (stage IV, 4 cm × 4 cm × 7 cm, extending to muscle). Comorbidities included coronary heart disease (30+ years), cerebral infarction (20+ years), left thigh tumour, coronary stent implantation (17 years prior), and inferior vena cava filter placement (6 months prior). Preoperative digital radiography (DR) revealed left lumbar scoliosis. Under real-time ultrasound guidance (2–5 MHz convex array probe), a paramedian longitudinal laminar oblique approach was used for L2–3 subarachnoid block. 3 mL of 0.4% ropivacaine was administered, achieving a sensory block to T10 (5 min post-injection) and Modified Bromage Scale (MBS) Grade 3 motor block. Intraoperatively, no additional anaesthetics were needed; vital signs remained stable, and Pain Assessment in Advanced Dementia (PAINAD) scores were consistently 0. Postoperatively, sensory/motor function fully recovered by 12 h (MBS Grade 0), with no anaesthesia-related complications. Long-term follow-up (3 months) showed improved activities of daily living and stable vital signs. Conclusion Real-time ultrasound-guided subarachnoid block is a safe and reliable anaesthetic option for elderly long-term bedridden patients with spinal deformity undergoing pressure ulcer repair. It enhances puncture accuracy, reduces complications, and accommodates positioning limitations, making it suitable for high-risk elderly populations.