ESRA Academy. Roberts M. Sep 9, 2016; 138317; 0146 Topic: Preoperative Considerations/ Safety /Complications
Dr. Mari Roberts
Dr. Mari Roberts

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Background and Aims:

The use of regional anaesthesia (RA) with pre-existing peripheral neuropathy is contentious. But as the boundaries of patient selection are continually challenged, more patients with substantial neurological co-morbidity will present for surgery. Guillain-Barre Syndrome (GBS) is an acute, inflammatory, demyelinating polyradiculoneuropathy, with cardio-respiratory complications. Up to 10% have severe residual disability. There are no reports or recommendations for RA use in GBS, apart from rare obstetric epidurals.


A 34 year old woman who had life-threatening GBS 4 years prior, presented for painful surgery on her hip. She was now minimally mobile with globally weakened respiratory function and required daily opioid analgesia for painful neuropathy.

To avoid copious use of opioids and cardio-respiratory complications, I chose to use a Fascia Iliaca Block (FIB) as my analgesic provision, after discussion with a tertiary Neuroanaesthesia Centre and The Neuroanaesthesia & Critical Care Society (UK). Pre-operatively, I documented a full neurological examination. After induction of general anaesthesia, tracheal intubation and the insertion of an arterial line, an in-plane, aseptic FIB was performed with continuous ultrasound imaging, using 20 millilitres of 0.25% Levobupivacaine.


The patient displayed no pressor response to surgery and was haemodynamically stable. She was easily extubated fully awake, with excellent analgesia. She returned to pre-existing neurology within 24 hours, with minimal opioids use and no respiratory sequelae.


This demonstrates that even in neuropathic patients, RA can have safety advantages and each case should be considered individually. Here, it was crucially important in minimising dangerous morbidity in a very vulnerable patient.

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