{
  "abstract": "Background\n\nMagnetic resonance-guided linear accelerators (MR-Linac) integrate magnetic resonance imaging (MRI) with radiotherapy delivery, enabling adaptive treatment. However, patient immobility is required for 60-90 min within a high-field magnet, making anaesthetic management challenging. Sedation may be inadequate in patients with opioid tolerance or obstructive sleep apnoea, while general anaesthesia (GA) poses significant risks due to airway and equipment limitations in the MR environment.Case presentation\n\nWe present a 78-year-old male with prostate cancer, severe chronic pain, opioid tolerance, and prior spinal instrumentation undergoing 28 MR-Linac sessions. Sedation attempts failed due to persistent involuntary leg movements and apnoea episodes. GA was deemed high-risk due to obesity, obstructive sleep apnoea, chronic opioid and alcohol use, and limited emergency access in the MR-Linac suite. Epidural anaesthesia was unfeasible due to adhesions from prior spinal surgery. A tunnelled intrathecal catheter was placed at the L3-L4 level, enabling daily intermittent spinal anaesthesia with 0.5% bupivacaine. All 28 fractions were completed uneventfully, without infection, neurological deficit, or catheter-related complications.Conclusion\n\nRepeated spinal anaesthesia delivered through a tunnelled intrathecal catheter enabled successful completion of MR-Linac radiotherapy in this carefully selected patient after conventional sedation had failed. This case highlights an individualized management approach for a challenging clinical scenario.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anaesthesiology, Dogus University, Istanbul, Turkey. hasankilic@dogus.edu.tr.",
    "Department of Anaesthesiology and Reanimation, Hisar Intercontinental Hospital, Istanbul, Turkey. hasankilic@dogus.edu.tr.",
    "Department of Anaesthesiology, Dogus University, Istanbul, Turkey.",
    "Department of Anaesthesiology and Reanimation, Hisar Intercontinental Hospital, Istanbul, Turkey."
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Hasan Huseyin Kilic"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Onur Bukagikiran"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c1kwy9ced8f3f.bib",
  "cited_by": 0,
  "doi": "10.1186/s12871-026-04108-z",
  "fulltext_url": "https://europepmc.org/articles/PMC13729659",
  "id": "c1kwy9ced8f3f",
  "issns": [
    "1471-2253"
  ],
  "landing_url": "https://europepmc.org/article/MED/42972256",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2746|Anesthesia and Pain Management"
    ]
  ],
  "openalex": "W7172510599",
  "pdf_url": "https://europepmc.org/articles/PMC13729659?pdf=render",
  "pmcid": "PMC13729659",
  "pmid": "42972256",
  "published": "2026-08-06",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/c1kwy9ced8f3f.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T15:20:49Z",
      "native_id": "MED:42972256",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42972256"
    },
    {
      "first_seen": "2026-11-07T12:22:22Z",
      "native_id": "PMC13729659",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12871-026-04108-z"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Anesthesia and Pain Management",
      "subfield": "surgery"
    }
  ],
  "title": "Tunnelled intrathecal catheter enabling repeated spinal anaesthesia in MR-Linac radiotherapy: a case report.",
  "title_text": "Tunnelled intrathecal catheter enabling repeated spinal anaesthesia in MR-Linac radiotherapy: a case report.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:22:22Z",
  "url": "https://research.draconitic.com/paper/c1kwy9ced8f3f",
  "venue": "BMC anesthesiology",
  "versions": []
}