Surgical drainage of a cutaneous abscess in patient with multiple sclerosis and Ehrles-danlos syndrome

a case report

Abstract

Introduction: Multiple sclerosis (MS) and Ehlers-Danlos syndrome (EDS) pose specific challenges to anesthetic management, particularly in the setting of active infection and polypharmacy. Careful selection of anesthetic technique is essential to minimize hemodynamic instability, neurological worsening, and tissue injury. Case report: A 38-year-old woman with MS, EDS and hypothyroidism, on beta-interferon, levothyroxine, escitalopram, zolpidem and daptomycin, was scheduled for surgical drainage of a cutaneous abscess in the lower limb. General anesthesia was induced with propofol and fentanyl and maintained with sevoflurane under spontaneous ventilation through a laryngeal mask airway. Ultrasound-guided femoral nerve block and lateral femoral cutaneous nerve block were performed using 0.5% ropivacaine to provide regional analgesia. Intraoperative monitoring showed stable hemodynamics, adequate oxygenation and ventilation, without adverse events. No new neurological deficits or block-related complications were observed in the immediate postoperative period. Conclusion: Low-dose balanced general anesthesia with laryngeal mask airway, spontaneous ventilation and ultrasound-guided peripheral nerve blocks proved to be a safe and effective strategy for abscess drainage in a patient with MS and EDS, and may be considered a prudent alternative to neuraxial anesthesia in similar complex scenarios.