Case Report: Ultrasound-Guided Neuroaxial Anesthesia in Pregnant Patient with Opioid-Allergic Achondroplasia

Abstract

Achondroplasia is a low prevalence genetic disorder characterized by disproportionate short stature and skeletal dysplasia, caused primarily by mutations in the fibroblast growth factor receptor 3 (FGFR3) gene associated with disturbances in bone growth. It is the most common form of dwarfism characterized by rhizomelic shortening of the limbs, macrocephaly with frontal bossing and spinal alterations, which presents significant challenges in the anesthetic management of pregnant women due to anatomical and physiological alterations, such as predictors of difficult airway, thoracic restriction due to bone dysplasias, spinal deformities and the multiple physiological changes characteristic of pregnancy. Achondroplasia has an increased incidence of menstrual disorders, infertility, amenorrhea, so conception is rare.

We report the case of a 29-year-old female patient diagnosed with achondroplasia and 37 weeks of pregnancy with cephalopelvic disproportion, with a history of opioid allergy documented by provocation test, who underwent elective cesarean section. After a detailed evaluation that included a careful spinal assessment with ultrasound to ensure the feasibility of the neuroaxial block, given the frequent technical difficulties associated, an ultrasound-guided neuroaxial block was chosen as the primary anesthetic technique due to the predictors of difficult airway and opioid allergy, which was performed with adjusted doses of local anesthetics, in addition to the preoperative use of intravenous non-opioid drugs to optimize intraoperative and postoperative pain control. The procedure passed without complications, and the multidisciplinary management allowed a satisfactory maternal-fetal evolution.