210 Application of peripheral nerve block on a patient with multiple sclerosis

Background and Aims Multiple Sclerosis (MS) is an autoimmune disease of the Central Nervous System (CNS) In our case, we present our anesthesia management applied on a MS patient. Our patient was 47 years old, 167 cm tall, 75 kg female and has been diagnosed with MS for 20 years. She had a left ankle fracture and had lower extremity surgery. Methods After visualizing the sciatic nerve in sub-gluteal region with a linear US probe in lateral decubid position, the neurostimulator was started at 2 Hz frequency at stimulation level of 0.8 mA with 0.1 ms intervals. When motor response was seen, the stimulation level was reduced to 0.4 mA. When motor response disappeared, 20 ml of 0.5% Bupivacaine hydrochloride (100 mg) was administered around the sciatic nerve with an 80 mm block needle. Afterwards, the patient was put in supine position.15 ml of 0.5% Bupivacaine (75 mg) was administered around the femoral nerve. Motor and sensory tests were applied 30 minutes after the procedure. Her vitals remained stable throughout the surgical operation. She was discharged to the orthopedic service. Results When a nondepolarizing muscle relaxant is used, resistance or sensitivity has been observed as a result of proliferation of extra-connective cholinergic receptors due to upper motor neuron plaques (3). Most of the limited studies, support US-guided peripheral nerve blocks in MS and report that this method should not be considered as a contraindication (4). Conclusions PSB can be safely applied without increasing morbidity and avoiding possible complications that may arise from the results of other anesthesia approaches.