Abstract
Purpose: To describe the clinical presentation of three patients with Charcot-Marie-Tooth disease, who underwent uneventful upper limb surgery following successful peripheral nerve blockade, and to review the anesthetic implications in patients with Charcot-Marie-Tooth disease.
Clinical features: In three patients with Charcot-Marie-Tooth disease presenting for surgery of the upper limb, the motor response, following nerve stimulation, was suboptimal. However, ultrasound guidance was effective in visualizing the needle-nerve interaction, and local anesthetic was injected around the nerves. Good block ensued and surgery proceeded in all patients without complications. No exacerbation of the neurological condition was observed in any patient.
Conclusions: Charcot-Marie-Tooth disease is a demyelinating, hereditary, motor and sensory neuropathy characterized by abnormalities of nerve conduction. Regional anesthesia of the upper limb is feasible in these patients, and these cases show that ultrasound guidance makes peripheral nerve block possible in patients for whom traditional methods of nerve localization fail.
Résumé
Objectif: Décrire la présentation clinique de trois patients souffrant de la maladie de Charcot-Marie-Tooth subissant une chirurgie d’un membre supérieur sans complications à la suite la mise en place réussie d’un bloc des nerfs périphériques, et réitérer les implications anesthésiques chez les patients souffrant de la maladie de Charcot-Marie-Tooth.
Éléments cliniques: Dans le cas de trois patients souffrant de la maladie de Charcot-Marie-Tooth se présentant pour une chirurgie d’un membre supérieur, la réaction motrice était sous-optimale après stimulation nerveuse. Cependant, l’échoguidage a permis de visualiser l’interaction entre l’aiguille et le nerf, et un anesthésique local a été injecté autour des nerfs. Ainsi, un bloc efficace a été réalisé et la chirurgie s’est déroulée sans complications chez les trois patients. Aucune exacerbation de l’état neurologique n’a été observée chez ces patients.
Conclusions: La maladie de Charcot-Marie-Tooth est une neuropathie sensori-motrice héréditaire due à une démyélinisation et caractérisée par des anomalies au niveau de la conduction nerveuse. L’anesthésie régionale des membres supérieurs est réalisable chez les patients souffrant de cette maladie, et les cas présentés ici montrent que l’échoguidage permet une anesthésie des nerfs périphériques chez les patients chez lesquels les méthodes conventionnelles de localisation des nerfs échouent.
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Dhir, S., Balasubramanian, S. & Ross, D. Ultrasound-guided peripheral regional blockade in patients with Charcot-Marie-Tooth disease: a review of three cases. Can J Anesth 55, 515–520 (2008). https://doi.org/10.1007/BF03016671
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DOI: https://doi.org/10.1007/BF03016671