Utility of neurostimulator-guided peripheral nerve blocks for limb surgery in patients with leprosy in a developing country

Introduction: Leprosy is a disease still present in many countries in Africa, Asia and Latin America mainly in disadvantaged areas where medical facilities are almost non existent [1]. Leprosy is a chronic infectious disease which causes peripheral neuropathy with severe deformities of the extremities as a result.

Objective: We describe the utility of peripheral nerve blocks and nerve stimulator (NS) guided peripheral nerve blocks (PNB) in patients affected by leprosy undergoing surgery.

Methods: We reviewed our institutional use of regional anesthesia in leprous patients between 2011 and 2015. Patients received baseline clinical neurological evaluation before and after PNB. All PNB's were performed with NS-guidance using either Ropivacaine 0.75% or Bupivacaine 0. 5% as local anesthetics.

Results: Seventy-three patients received a total of 102 PNB's, with a mean age of 28 years [14-80] and a sex ratio of 0.25 (M:F). Forty-four axillary blocks were performed for ulnar (58.09%), median (40.9 %) and cubital-median (28.5 %) neurolysis. 29 combined sciatic and femoral nerve blocks were performed for posterior tibial neurolysis (70 %) and leg amputations (30%).Median current intensity to elicit electro motor response was 0.4 mA. The average block on set time was 20 minutes with a 94% success-rate and average duration of sensory block was 18 hours. After 6 months, 84.5% of all patients were re assessed without evidence of neurologic deficit.

Conclusion: Leprosy continues to be rampant in developing countries. Patients whose peripheral nerves are affected often require limb surgery. Our data suggests that the practice of NS guided PNB successfully provides anesthesia and analgesia during these procedure.