Taylor’s Approach to Rescue: A Case of Undiagnosed Alkaptonuria Undergoing Bilateral Total Knee Replacement

Abstract

Alkaptonuria is a rare inherited autosomal recessive metabolic disorder due to the deficiency of homogentisic acid oxidase resulting in accumulation of homogentisic acid in collagen and cartilaginous tissue resulting in stiffening of joints, spine and involving other systems which pose challenges to anaesthesiologist in providing anaesthesia. Here we present a patient with undiagnosed alkaptonuria who was posted for bilateral total knee replacement. Since these patients usually have reduced intervertebral spaces, neuraxial anaesthesia was difficult with classic approach. Taylor’s approach was used for neuraxial anaesthesia and, post-operative analgesia was achieved with continuous femoral nerve block with catheter placement.