Paul O. Raphael1, Binu P. Simon2, Revi N3, Preethi Susan4
Arthrogryposis multiplex congenita (AMC) refers to a syndrome of unknown etiology with multiple congenital contractures in one or more joints with a concomitant inability of passive extension and flexion. The overall prevalence of arthrogryposis is one in 3000 live births. The extensive contractures, tense skin, minimal muscle mass and subcutaneous tissue pose challenges in anaesthetic management. We report a seven year old boy (15 kg), known case of AMC with congenital talipes equino varus (CTEV) and bilateral hip dislocation posted for right sided herniotomy and orchidopexy. We planned to combine general anaesthesia without muscle relaxants and regional nerve block. The child was induced with propofol and Classic LMA Size 2 was inserted. An ilioinguinal and iliohypogastric nerve block was given under ultrasound guidance using 0.2% ropivacaine. Pateint remained hemodynamically stable during surgery with minimal anaesthetic requirement and no anlgesics. Analgesia lasted for 8 hours postoperatively. Combining narcosis with regional anaesthesia leads to a reduced demand for anaesthetics, stable circulatory conditions, maintenance of spontaneous breathing, prevention of stress and sufficient postoperative analgesia.
