Caudal epidural block instead of general anesthesia in an adult with Duchenne muscular dystrophy

Shabana Z Shafy,1 Mohammed Hakim,1 Mauricio Arce Villalobos,1 Gregory D Pearson,2,3 Giorgio Veneziano,1 Joseph D Tobias1,4 1Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 2Department of Plastic Surgery, Nationwide Children’s Hospital, Columbus, OH, USA; 3Department of Plastic Surgery, The Ohio State University, Columbus, Ohio, USA; 4Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, Ohio, USA Abstract: Duchenne muscular dystrophy (DMD), first described in 1834, is an X-linked dystrophinopathy, leading to early onset skeletal muscle weakness. Life expectancy is reduced to early adulthood as a result of involvement of voluntary skeletal muscles with respiratory failure, orthopedic deformities, and associated cardiomyopathy. Given its multisystem involvement, surgical intervention may be required to address the sequelae of the disease process. We present a 36-year-old adult with DMD, who required anesthetic care during surgical debridement of an ischial pressure sore. Given his significant respiratory muscle involvement, ultrasound-guided caudal epidural anesthesia was used instead of general during the surgical procedure. The technique and its applications are discussed, with particular emphasis on the feasibility and safety of using regional anesthetic techniques in patients with DMD. Keywords: Duchenne’s muscular dystrophy, caudal epidural, regional anesthesi