Patients with sequelae of poliomyelitis. Does the anesthetic technique impose risks?

Several questions arise before performing neuro-axis block in patients with sequelae of poliomyelitis. Reports in the literature are scarce. The objective of this study was to describe the anesthetic techniques used in patients undergoing surgeries and possible complications.

We undertook a retrospective study of patients with sequelae of poliomyelitis who underwent surgeries during a five-year period. Demographic data, physical status (ASA), onset of the disease, body part affected, diagnosis of post-poliomyelitis syndrome, surgeries and type anesthesia used, postoperative analgesia, intra- and postoperative complications, outpatient follow-up, and development of neurological changes were evaluated.

One-hundred and twenty-three patients who underwent 162 surgical procedures were evaluated. Most patients (n = 82; 66.6%) had neurological sequela in a lower limb. Patients developed acute poliomyelitis at approximately 28 months of age. Orthopedic surgery was performed in 87.7% of patients. Neuro-axis block was used in 64.1% of the cases; epidural block was more frequent. Intraoperative complications reported included: accidental puncture of the dura-mater (n = 1; 0.61%), bradycardia (n = 1; 0.61%), hypotension (n = 2; 1.23%), and apnea and thoracic rigidity (n = 1; 0.61%). Postoperative complications included: vomiting (n = 2; 1.23%), urinary retention (n = 4; 2.64%), and complex regional pain syndrome type 1 (n = 2; 1.23%). Patients were followed for 22 months and worsening of the neurological disorder was not observed.

Patients with sequelae of poliomyelitis who underwent neuro-axis block did not develop any postoperative complications or worsening of their neurological status that could be attributed to the anesthetic technique used.