Anesthetic Considerations for Ivor-Lewis Esophagectomy in a Patient With Hereditary Spastic Paraplegia: A Case Report

Hereditary spastic paraplegia (HSP), also known as familial spastic paraparesis or Strümpell-Lorrain disease, is a rare group of inherited disorders characterized by progressive spastic weakness in the lower limbs due to axonal degeneration of the corticospinal tracts. We describe the anesthetic management of a 52-year-old man with HSP who underwent an Ivor-Lewis esophagectomy for esophageal adenocarcinoma. This is the first report in the literature describing the anesthetic management of a patient with HSP successfully undergoing complex thoracoabdominal surgery. Key to the provision of postoperative analgesia was the intraoperative placement of catheters in the right thoracic paravertebral space and retro-rectus plane for continuous infusion of ropivacaine 0.2% for 3 days, as well as a fentanyl patient-controlled analgesia for 7 days.