Continuous axillary block for upper limb surgery in a patient with epidermolysis bullosa simplex

We report the use of continuous regional block with light general anaesthesia in epidermolysis bullosa simplex. A 4-year-old girl suffering from florid epidermolysis bullosa simplex was scheduled for external fixator (JESS) for manus valgus deformity of the left forearm. Haemoglobin was 7.6 g.dl(-1) and blood chemistry was normal. She had no history of oral bullae, although a younger sibling had died of Bart syndrome with oral lesions. She was sedated with nasal midazolam 0.5 mg.kg(-1). All pressure points were cushioned. Inhalational anaesthesia was given by holding a mask above her face. Only oximetry and capnography were monitored. ECG and noninvasive blood pressure monitoring were avoided. The intravenous cannula was fixed by sutures. An epidural catheter of 0.63 mm OD (21-G) was passed into the axilla for continuous axillary block. Intra- and postoperative course was uneventful with slight bullae at the i.v. site and at the fixator which healed without further damage. The axilla remained free of problems. Continuous peripheral plexus or nerve blocks can be an option in these difficult patients, and can minimize the amount of general anaesthesia along with problems of airway handling and potential subsequent mucosal lesions. The postoperative period was pain free and comfortable.