Interscalene brachial plexus block for shoulder surgery in a patient with arthrogryposis multiplex congenita

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Orthopedic Surgery

Background:

• Arthrogryposis multiplex congenita (AMC) presents significant anesthetic challenges, including difficult airways and potential respiratory compromise.
• Children with AMC often suffer from malnutrition, further complicating surgical risk assessment and management.
• Chronic osteomyelitis of the humerus head requires surgical intervention, necessitating careful perioperative planning.

Observation:

• A five-year-old child with severe AMC and malnutrition was scheduled for surgery.
• The patient exhibited typical AMC features, including a challenging airway.
• Propofol was utilized for anesthetic induction and maintenance, preserving spontaneous respiration via a nasal airway.
• An interscalene brachial plexus block, guided by a nerve stimulator, provided effective analgesia without opioids.

Findings:

• The anesthetic approach successfully managed the difficult airway associated with AMC.
• Postoperative pain was effectively controlled using a regional block, avoiding opioid administration.
• The surgical procedure for osteomyelitis was completed with an uneventful recovery.

Implications:

• This case underscores the feasibility of utilizing propofol and regional anesthesia in pediatric AMC patients.
• Effective airway management and opioid-sparing analgesia are crucial for favorable outcomes in AMC surgery.
• Further research into anesthetic techniques for AMC is warranted to optimize patient care.