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Anesthetic Considerations for Ivor-Lewis Esophagectomy in a Patient With Hereditary Spastic Paraplegia

A Case Report

Yang, Phillip F., MBBS, MS*,†; Links, David J. R., MBBS, MS, FRACS*; Petrovski, Johnny, MBBS, FANZCA

doi: 10.1213/XAA.0000000000000811
Case Reports

Hereditary spastic paraplegia (HSP), also known as familial spastic paraparesis or Strümpell-Lorrain disease, is a rare group of inherited disorders characterized by progressive spastic weakness in the lower limbs due to axonal degeneration of the corticospinal tracts. We describe the anesthetic management of a 52-year-old man with HSP who underwent an Ivor-Lewis esophagectomy for esophageal adenocarcinoma. This is the first report in the literature describing the anesthetic management of a patient with HSP successfully undergoing complex thoracoabdominal surgery. Key to the provision of postoperative analgesia was the intraoperative placement of catheters in the right thoracic paravertebral space and retro-rectus plane for continuous infusion of ropivacaine 0.2% for 3 days, as well as a fentanyl patient-controlled analgesia for 7 days.

From the *Department of Surgery, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia

University of New South Wales, Sydney, New South Wales, Australia

Department of Anaesthetics, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia.

Accepted for publication April 30, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Phillip F. Yang, MBBS, MS, Department of Surgery, Prince of Wales Hospital, Barker St, Randwick, NSW 2031, Australia. Address e-mail to

© 2018 International Anesthesia Research Society
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