Continuous Spinal Anaesthesia in a Leprosy Patient with Femur Fracture

Abstract

Introduction: Leprosy is a chronic infectious disease caused by Mycobacterium leprae and affects the skin and nerves. Leprosy patients in which peripheral neuropathy and the involvement of other organs may have dysautonomia in the heart and respiratory system and autonomic involvement. Case Report: A 65 year-old patient was posted for fixing of right intertrochanteric with left subtrochanteric fracture femur. The possibility of a difficult airway was considered because of the mouth and nose deformities. Difficult airway equipment, such as a fibre-optic bronchoscopy and laryngeal mask (LMA) were made available. The patient’s vitals were normal. The haemogram and biochemistry measurements were normal. Under aseptic conditions in the sitting position at the L3–4 level, the subarachnoid space was identified with a 18-G Tuohy needle, the catheter was threaded into subarachnoid space and fixed at 10cm.1.2 mL(6mg) of 0.5% hyperbaric bupivacaine (6mg) administered. After 1hour from the starting of procedure, again 1.2 ml(6mg) of 0.5% hyperbaric bupivacaine administered through the catheter. Level achieved till T10. BP was 72/42mmHg, treated with 12mg Mephentermine. Inj.Fentanyl 50mcg given through the catheter and the catheter was removed. Conclusion: Appropriate assessment before anaesthesia and preparation are important in the management of anaesthesia of patients with leprosy. Regional anaesthesia can be used as an alternative for patients without autonomic neuropathy and with a suspicion of systemic involvement and with difficult intubation Keywords: Continuous spinal anaesthesia; Leprosy; Regional anaesthesia.