In this case report, we describe the use of ultrasound in the administration regional anesthesia for a super-super obese patient. A 23-year-old female patient (height 167.2 cm, weight 191.5 kg, body mass index 68.6 kg/m²) was admitted to the hospital for surgical repair of an anterior talofibular ligament rupture. We used ultrasound to help facilitate the administration of regional anesthesia. In the sagittal view of the lumbar spine, (with the patient in a sitting position) we were able to identify the border between the sacrum and the lumbar vertebral; in the transverse view, we were able to identify the transverse process, posterior dura, vertebral body, and the distance from the skin to the posterior dura. After skin marking, regional anesthesia was successfully performed. Based on this case study, we suggest that ultrasound can be very useful in regional anesthesia for severely obese patients.

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• Anaesthetic implications in a case of super obesity with multiple comorbidities: A conundrum of challenges
  Sathya Narayanan K, Ilango Ganesan, Gowtham Rajan, Nithya Dhanabal, Teresa Mary, Rajalakshmy Aarthy
  Indian Journal of Clinical Anaesthesia.2023; 10(1): 106.     CrossRef