Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes

Background and Aims Neuromyelitis Optica Spectrum Disorder (NMOSD) is described as an autoimmune disease causing the inflammation of astrocytes. This demyelinating disease of the central nervous system affects the spinal cord and the optic nerve, causing neuritis of one or another. The effect of local anaesthetics in patients with demyelinating diseases is not as predictable as in healthy patients and might lead to prolonged nerve block duration.

Methods A 51-year-old female patient suffering from Devic´s Disease presented in our anaesthesia clinic prior to hysteroscopy. In the light of her medical history, including COPD and obesity (BMI 36.7, 165 cm, 100 kg), we decided to perform a spinal anaesthesia using a short-acting local anaesthetic in the hope of preventing long block duration. The spinal anaesthesia was performed with a 25G spinal needle and 3.5 ml of Prilocaine 2% (Takipril).

Results The extent of the block reached TH 8 level, lasting for 5 hours. Against our expectations, the block did not show a sufficient effect as the patient felt uncomfortable having minor pain perception – although the initial expansion of the block began in a typical manner. A general anaesthesia became necessary during the operation. This is in complete contrast to the experiences of her previous spinal anaesthesia, showing a sufficient block with a duration of 20 hours.

Conclusions Spinal anaesthesia seems to be a viable option for patients with NMOSD. The manifestation of a nerve block remains somewhat unpredictable in this case. Sufentanil or morphine might be expedient adjuncts.