Department of Anesthesiology, Deputado Afonso Guizzo Hospital, Araranguá, SC, Brazil.
Department of Anesthesiology, Newton-Wellesley Hospital, Mass General Brigham, Boston, MA, USA.
Can J Anaesth. 2024 Oct;71(10):1372-1378. doi: 10.1007/s12630-024-02832-z. Epub 2024 Sep 17.
Charcot-Marie-Tooth (CMT) disease is an inherited neurologic disorder characterized by progressive peripheral neuropathies. The use of peripheral nerve blocks (PNB) in patients with CMT disease has been controversial because of concerns about exacerbating existing neurologic impairments and the "double hit" hypothesis. We aimed to assess the use of PNB in pediatric patients with CMT disease undergoing orthopedic surgery to address the limited data available in the literature on this topic.
In this retrospective cohort study, we included all pediatric patients with CMT disease scheduled for orthopedic surgery receiving PNB at our centre. All of the patients had preoperative neurologic exams and received one or more ultrasound-guided regional anesthesia techniques. Data extracted included details of anesthesia technique, surgical procedure, opioid consumption, and pain scores during the first three postoperative days. We also reviewed any complications such as neurologic deficits and local anesthetic toxicity. We used descriptive statistics to summarize the findings.
We included 25 patients, 14 of whom (56%) presented with pre-existing neurologic deficits, primarily in the lower extremities. Postoperative assessments revealed no new neurologic impairments in 24/25 (96%) patients, with only one patient experiencing a nerve injury possibly related to the surgical procedure. Opioid consumption was low in the postanesthesia care unit and on the day of surgery. No additional complications were noted in the first 72 hr after surgery.
Despite concerns, PNB showed favourable outcomes in a pediatric cohort with CMT disease, with low opioid consumption and pain scores and minimal complications during follow-up. These findings match previous reports of adult patients with CMT disease and suggest that the benefits of PNB may outweigh the perceived risks in pediatric patients with CMT disease.
Charcot-Marie-Tooth（CMT）病是一种遗传性周围神经病，其特征为进行性周围神经病。由于担心加重现有神经损伤和“双重打击”假说，CMT 病患者使用外周神经阻滞（PNB）存在争议。我们旨在评估 PNB 在接受矫形外科手术的 CMT 病儿科患者中的使用情况，以解决该主题文献中有限的数据。
在这项回顾性队列研究中，我们纳入了在我们中心接受 PNB 治疗的所有接受矫形外科手术的 CMT 病儿科患者。所有患者均进行了术前神经检查，并接受了一种或多种超声引导的区域麻醉技术。提取的数据包括麻醉技术、手术程序、阿片类药物消耗和术后前 3 天的疼痛评分的详细信息。我们还回顾了任何并发症，如神经功能缺损和局部麻醉毒性。我们使用描述性统计来总结发现。
我们纳入了 25 名患者，其中 14 名（56%）存在预先存在的神经功能缺损，主要在下肢。术后评估显示 25 名患者中的 24 名（96%）无新的神经损伤，只有 1 名患者可能与手术相关的神经损伤。术后恢复室和手术当天的阿片类药物消耗较低。术后 72 小时内未出现其他并发症。
尽管存在担忧，但 PNB 在患有 CMT 病的儿科患者中显示出良好的结果，阿片类药物消耗和疼痛评分低，随访期间并发症少。这些发现与 CMT 病成年患者的先前报告一致，表明 PNB 的益处可能超过患有 CMT 病的儿科患者的感知风险。
