title: Peripheral nerve blocks as the sole anesthetic technique in a patient with severe Duchenne muscular dystrophy.
abstract: General anesthesia and central neuraxial blockades in patients with severe Duchenne muscular dystrophy are associated with high risks of complications, including rhabdomyolysis, malignant hyperthermia, hemodynamic instability, and postoperative mechanical ventilation. Here, we describe peripheral nerve blocks as a safe approach to anesthesia in a patient with severe Duchenne muscular dystrophy who was scheduled to undergo surgery. A 22-year-old male patient was scheduled to undergo reduction and internal fixation of a left distal femur fracture. He had been diagnosed with Duchenne muscular dystrophy at 5 years of age, and had no locomotive capability except for that of the finger flexors and toe extensors. He had developed symptoms associated with dyspnea 5 years before and required intermittent ventilation. We blocked the femoral nerve, lateral femoral cutaneous nerve, and parasacral plexus under ultrasound on the left leg. The patient underwent a successful operation using peripheral nerve blocks with no complications. In conclusion general anesthesia and central neuraxial blockades in patients with severe Duchenne muscular dystrophy are unsafe approaches to anesthesia because of hemodynamic instability and respiratory depression. Peripheral nerve blocks are the best way to reduce the risks of critical complications, and are a safe and feasible approach to anesthesia in patients with severe Duchenne muscular dystrophy.
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Seung Uk
authors.initials: SU
authors.lastname: Bang
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea. yskcmc4897@nate.com.|, 327, Sosa-ro, Wonmi-gu, Bucheon City, 14647, Kyunggido, Republic of Korea. yskcmc4897@nate.com.
authors.forename: Yee Suk
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Kwon
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Sang Mook
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Soo Hyang
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects; D000777:Anesthetics / Q000008:administration & dosage*; D005267:Femoral Nerve; D006801:Humans; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000601:surgery*; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D012306:Risk; D055815:Young Adult
chemical_list: D000777:Anesthetics
keywords: Anesthesia; Duchenne; Malignant hyperthermia; Muscular dystrophy; Nerve block