Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA.
Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
Can J Anaesth. 2022 Jul;69(7):880-884. doi: 10.1007/s12630-022-02258-5. Epub 2022 Apr 25.
Anesthetic management for patients with Charcot-Marie-Tooth disease (CMT) is controversial. Description of the use of regional anesthesia (RA) in patients with CMT is limited. Regional anesthesia has traditionally been avoided because of risk of nerve injury. We retrospectively reviewed patients with CMT who received RA at our institution.
We performed a historical cohort study of all patients with CMT who received RA from 30 April 2010 to 30 April 2020 within our institution. Charts were reviewed for information on demographics, RA procedures, perioperative variables, evidence of neurologic complications, post-RA neurology consults, and perioperative electromyography (EMG) results. Electromyographs were reviewed by a neurologist who was blinded to the surgical and RA details.
Fifty-three patients received a total of 132 regional anesthetics during the study period. Twenty-five patients received RA on more than one occasion. Fifty-five EMGs and 14 postoperative neurology consults were performed. Two patients had neurology consults with peripheral nerve block (PNB) distribution complaints years later. Neither attributed the complaints to the PNB. The other neurology consults were for unrelated complaints. No EMG results suggested injury related to PNB.
This study found no evidence of documented neurologic complications or an increased risk of nerve injury related to RA in CMT patients.
对于肌萎缩性侧索硬化症（CMT）患者的麻醉管理存在争议。有关 CMT 患者使用区域麻醉（RA）的描述有限。由于存在神经损伤的风险，RA 传统上被避免使用。我们回顾性分析了在我院接受 RA 的 CMT 患者。
我们对 2010 年 4 月 30 日至 2020 年 4 月 30 日期间在我院接受 RA 的所有 CMT 患者进行了历史队列研究。对病历进行了评估，以获取有关人口统计学、RA 程序、围手术期变量、神经并发症证据、RA 后神经科会诊以及围手术期肌电图（EMG）结果的信息。EMG 由一位对手术和 RA 细节一无所知的神经科医生进行审查。
在研究期间，53 名患者共接受了 132 次 RA。25 名患者接受了超过一次 RA。共进行了 55 次 EMG 和 14 次术后神经科会诊。两名患者在数年后面诊时出现了 PNB 分布性抱怨，但都没有将这些抱怨归咎于 PNB。其他的神经科会诊是为了其他的抱怨。没有 EMG 结果表明与 PNB 相关的损伤。
本研究未发现有记录的神经并发症或与 CMT 患者 RA 相关的神经损伤风险增加的证据。
