Rivera-Pérez Dennys, Rosa-Carrasquillo Cristian, Reyes-Sullivan Allan J, Torres-Pérez Hector, Crespo Maria J
Anesthesiology, University of Puerto Rico, Medical Sciences Campus, San Juan, USA.
Cureus. 2023 Jun 13;15(6):e40363. doi: 10.7759/cureus.40363. eCollection 2023 Jun.
There are no established guidelines regarding anesthesia with a peripheral nerve block (PNB) in the young adult population with von Willebrand disease (vWD) type I. We present a case of a successful PNB outcome in a 20-year-old male patient with vWD type I, osteogenesis imperfecta (OI), and rheumatoid arthritis (RA) who underwent an intramedullary nailing surgery after suffering a left distal femur fracture secondary to a sports injury. Before the procedure, the patient was treated with HUMATE-P® [antihemophilic factor and von Willebrand factor (human)], ALPHANATE (antihemophilic factor/von Willebrand factor complex), and aminocaproic acid for hematologic control. Left femoral and popliteal nerve blocks were performed for postoperative pain control. The patient was discharged home uneventfully three days after the surgery. In this case, PNB proved to be a safe and effective alternative in the management of a vWD type I young adult patient with comorbidities. Given the lack of established guidelines, a multidisciplinary team should be involved in the pre and perioperative management of these patients due to the risk of delayed bleeding.
对于患有I型血管性血友病（vWD）的年轻成年人群，目前尚无关于外周神经阻滞（PNB）麻醉的既定指南。我们报告了一例20岁男性I型vWD患者，该患者同时患有成骨不全症（OI）和类风湿性关节炎（RA），因运动损伤导致左股骨远端骨折后接受了髓内钉手术，PNB取得了成功。术前，患者接受了HUMATE-P®[抗血友病因子和血管性血友病因子（人源）]、ALPHANATE（抗血友病因子/血管性血友病因子复合物）和氨基己酸治疗以控制血液学指标。为控制术后疼痛，实施了左股神经和腘神经阻滞。术后三天，患者顺利出院。在该病例中，PNB被证明是管理患有合并症的I型vWD年轻成年患者的一种安全有效的替代方法。鉴于缺乏既定指南，由于存在延迟出血的风险，多学科团队应参与这些患者的术前和围手术期管理。
