ESRA19-0292 Spinal anesthesia in a patient with charcot-marie tooth disease: a case report. (30th August 2019)

• Record Type: Journal Article
• Authors: Roriz, D; Brandão, J; Ribas, D; Graça, R; Barros, J; Caramelo, S; Abrunhosa, R
• Is Part Of: Regional anesthesia and pain medicine. Volume 44(2019)Supplement 1
• Page Start: A138
• Page End: A138
• Publication Date: 2019-08-30
• Subjects: Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1136/rapm-2019-ESRAABS2019.188
• Languages: English
• ISSNs: 1098-7339

Abstract

Abstract : Background and aims: Charcot-Marie Tooth disease (CMT) is a hereditary peripheral neuropathy characterized by progressive muscular atrophy and motor-sensory disorders that can lead to muscle weakness and sensory loss, especially in the extremities. We present a clinical case of a patient with CMT who underwent spinal anesthesia for limb orthopedic surgery. Methods: A 63-year-old male, classified as ASA II, was scheduled for tibiotarsal arthrodesis due to CMT sequelae. Past medical history included type 1 CMT and dyslipidemia. Physical examination revealed a high arched left foot with slight muscle weakness of the lower limbs and left foot paresthesia, without other neurological deficits. We decided to perform the procedure under spinal anesthesia using 10 mg hyperbaric bupivacaine 0.5% and 2 mcg sufentanyl (L3-L4 level, beveled 27G needle), without immediate vascular or neurological complications. Results: The patient remained hemodynamically stable throughout the procedure and no adverse events were registered. After surgery, the patient gradually regained motor function until full recovery 4 hours after the block. The immediate post-operative period was uneventful, and the patient was safely discharged home 2 days later without further neurologic impairment. Conclusions: There is no definitive consensus about the safety and use of regional anesthesia in patients with CMT, only a few case reports and small case series suggesting it can be used without worsening a patient's stable neurologic condition. We report a successful clinical case in which neuraxial anesthesia proved both safe and effective in this setting, in agreement with previous descriptions. Additional studies addressing this matter are required.