Peripheral nerve block in a patient with amyotrophic lateral sclerosis

Sertöz, Nezih; Karaman, Semra

doi:10.1007/s00540-011-1268-3

Cited by 7 publications

(3 citation statements)

References 2 publications

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“…One group reported using a lumbar plexus catheter and single-shot sciatic nerve block for a femoral neck fracture repair in a patient with ALS. This patient experienced no perioperative complications or progression of neurologic disease at three months follow-up [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Neuraxial and Regional Anesthesia in a Patient With Amyotrophic Lateral Sclerosis: A Case Report

Samworth¹,

Miller²,

Haswah³

et al. 2023

Cureus

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Patients with amyotrophic lateral sclerosis (ALS) who undergo lower extremity joint arthroplasty are rarely encountered. Patients with ALS are at an increased risk for perioperative anesthetic complications. Anesthetic techniques, regional or general, present different risks to patients with ALS. The historical concern of worsening pre-existing neurologic symptoms with regional anesthesia is being re-examined in light of emerging evidence supporting its use in patients with ALS. Here, we present the successful perioperative management of a patient with severe bulbar ALS undergoing total knee arthroplasty. Despite his advanced bulbar symptoms, he was independently ambulatory with severe knee pain related to osteoarthritis. During multidisciplinary planning with the patient and his wife, it became clear that his primary perioperative concern was avoiding intubation, prolonged ventilation, and tracheostomy placement. With this in mind, we planned for a neuraxial anesthetic without intraoperative sedation, a postoperative adductor canal peripheral nerve block, and multimodal non-opioid analgesia. There were no perioperative complications. At the six-week follow-up, he experienced improved ambulation and showed no signs of worsened ALS symptoms.

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Section: Discussionmentioning

confidence: 99%

“…Alternatively, regional anesthesia is traditionally avoided in patients with ALS, as it may worsen pre-existing neurologic symptoms [ 6 , 7 ]. However, there is growing support and evidence for the safe use of regional anesthetic techniques in patients with ALS [ 5 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Neuraxial and Regional Anesthesia in a Patient With Amyotrophic Lateral Sclerosis: A Case Report

Samworth¹,

Miller²,

Haswah³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Regional anesthesia, including local infiltration and peripheral and neuraxial nerve blocks, has been successfully used in patients with neuromuscular disorders to avoid possible respiratory and other complications associated with general anesthesia and opioid use [ 11 , 12 ]. Agnoletti et al's description of a thoracic paravertebral block (TPVB) for breast surgery in a patient with ALS is the only report similar to ours published in the English literature [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Thoracic Paravertebral Block, Multimodal Analgesia, and Monitored Anesthesia Care for Breast Cancer Surgery in Primary Lateral Sclerosis

Dizdarevic

Fernandes

2016

Case Reports in Anesthesiology

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Objective. Primary lateral sclerosis (PLS) is a rare idiopathic neurodegenerative disorder affecting upper motor neurons and characterized by spasticity, muscle weakness, and bulbar involvement. It can sometimes mimic early stage of more common and fatal amyotrophic lateral sclerosis (ALS). Surgical patients with a history of neurodegenerative disorders, including PLS, may be at increased risk for general anesthesia related ventilatory depression and postoperative respiratory complications, abnormal response to muscle relaxants, and sensitivity to opioids, sedatives, and local anesthetics. We present a case of a patient with PLS and recent diagnosis of breast cancer who underwent a simple mastectomy surgery uneventfully under an ultrasound guided thoracic paravertebral block, multimodal analgesia, and monitored anesthesia care. Patient reported minimal to no pain or discomfort in the postoperative period and received no opioids for pain management before being discharged home. In patients with PLS, thoracic paravertebral block and multimodal analgesia can provide reliable anesthesia and effective analgesia for breast surgery with avoidance of potential risks associated with general anesthesia, muscle paralysis, and opioid use.

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