Anesthesia in a child with arthrogryposis multiplex congenita – how to proceed: A case report

Arthrogryposis multiplex congenita (AMC) consists of a heterogenous group of disorders characterized by non-progressive congenital joint contractures. They have tense skin, minimal subcutaneous tissue, and muscle mass. The anesthetic management of these children is complicated by associated congenital abnormalities, airway anomalies, congenital heart disease, pulmonary hypoplasia, and vertebral anomalies. We managed a case of AMC with bilateral contractures of both upper and lower limb and neck who presented for correction of bilateral equino varus.

Study of morphine with ropivacaine and ropivacaine alone for caudal epidural analgesia in children

Background: Caudal epidural analgesia is one of the most popular and commonly performed regional blocks in pediatric anesthesia. It is reliable and safe technique that can be used with general anesthesia for intraoperative and postoperative analgesia. The aim of this research is to study the effect of morphine (15 µg/kg) with ropivacaine (0.2%) and ropivacaine (0.2%) alone through caudal epidural route on duration of analgesia in children.Methods: The study was performed on 60 ASA grade I and II patients, aged 1 to 7 years scheduled for elective infraumbilical surgeries. After induction of general anesthesia, caudal epidural block was performed. Each group consisted of 30 pediatric patients: group I-caudal epidural 0.2% ropivacaine (1 ml/kg) and group II- caudal epidural 0.2% ropivacaine (1 ml/kg) with morphine 15 µg/kg. Intra-operatively heart rate, blood pressure was recorded at pre-induction, immediately after induction, 5 minutes after administration of caudal block and thereafter every 10 minutes till the completion of surgery. Postoperative heart rate, blood pressure, pain score was assessed periodically till 24th hour.Results: The duration of analgesia was more in group II (7.30±1.78 hour) in comparison to group I (3.93±0.83 hour). The fall in mean arterial pressure and heart rate were not significant in group II as compared to group I.Conclusions: Addition of low dose morphine to ropivacaine resulted in prolonging the duration of analgesia by almost double the duration as compared to ropivacaine alone.