Parkinson's Disease and Spinal Anaesthesia

Parkinson's is a neurodegenerative disease characterized by increased activity of GABA in basal ganglia and the loss of dopamine in nigrostriatum, associated with rigidity, resting tremor, gait with accelerating steps, and fixed inexpressive face. Being a neurological disease, spinal anaesthesia is often avoided in Parkinson's. Yet, in Parkinsons' patients, general anaesthesia may mask neurological symptoms in the intraoperative period and exacerbate them postoperatively. Moreover, the drugs administered in general anaesthesia more likely interact with anti-Parkinson drugs and may have side effects. With spinal anaesthesia, unlike general anaesthesia, because muscle relaxants and opioids are avoided, the exacerbation is not going to be masked due to muscle relaxation, and neurological symptoms may be distinguished clinically. In addition, the known effects of spinal anaesthesia, like suppression of surgical stress, postoperative pain relief, and early mobilization, may be advantageous in Parkinson's disease. Treated for Parkinson's disease for about 10 years at the age of 77 and with American Society of Anesthesiologists physical classification III (hyperlipidemia, hypertension, coronary artery disease, and chronic obstructive lung disease), a female patient was scheduled for elective surgery for fracture of the left distal tibia. In this case, we aimed to report a patient with Parkinson's disease who underwent spinal anaesthesia in order to avoid the disadvantages of general anaesthesia and reviewed the literature.