Neuroaxial anesthesia in a patient with progressive systemic sclerosis : case presentation and review of the literature on systemic sclerosis

Abstract

BackgroundSystemic sclerosis (SSc), a progressive disease characterized by excessive accumulation of connective tissue components. Although most patients have long survival, some of them progress rapidly to death. Pulmonary system involvement and pulmonary hypertension are the most frequent cause of death. When the patient with SSc is to be operated, the anesthetic procedure could be a serious problem. In this article, we report a combined spinal – epidural technique in a patient with progressive SSc and the anesthetic considerations that could be recommended for these patients.Case presentationA 68-year-old woman who had a history of progressive systemic sclerosis, pulmonary fibrosis, kyphoscoliosis and decreased oral apertura underwent total hip arthroplasty. This operation was performed successfully under combined spinal epidural anesthesia.ConclusionSystemic sclerosis is a complex disease that involves multiple organ systems. Every aspects of anesthetic care may be altered or hindered by the pathogenesis of disease. Although the choice of regional or general anesthesia is unclear, to choose combined spinal epidural anesthesia may be useful.

Systemic sclerosis: Clinical manifestations, anesthetic and orthopedic considerations in a patient

“…It should be kept in mind that owing to decreased circulation and fibrosis of tissue, the duration of action of local anesthetic may be prolonged. Review of literature has revealed that a smaller dose of local anesthesia is required [26] .…”

The role of regional and neuroaxial anesthesia in patients with systemic sclerosis

“…Regional anesthesia may be limited, however, by technical difficulties, prolonged sensory blockade, unpredictable spread of local anesthetics,27,47,49,50 and associated with marked cardiovascular compromise 27…”

“…The six more recent case reports of neuroaxial anesthesia in patients with SSc do not report prolongation of block. Agents used were bupivacaine, ropivacaine, and prilocaine 27,49,50,55–57…”

“…Epidural anesthesia and CSE techniques have been used successfully without major complication for peripheral and major surgery, including mitral valve surgery49,55–57 and offer the benefit of continued regional analgesia into the postoperative period. However, epidural catheters have been associated with fibrosis when used for prolonged periods in these patients 2…”

Ultrasound-Guided versus Fluoroscopy-Guided Deep Cervical Plexus Block for the Treatment of Cervicogenic Headache

“…Thus, several local anesthetic techniques have been used in treating CeH, including occipital nerve blocks, cervical facet joint blocks, and cervical epidural injections [ 8 – 11 ]. Real time fluoroscopy imaging guidance is frequently required to ensure correct needle placement [ 12 – 14 ]. However, repeated exposure to radiation is a great threat to the health of physicians.…”