37 Regional anaesthesia and severe haemophilia. Is a continuous femoral nerve block safe? a case report

Background and Aims Peripheral nerve blocks may be used in haemophilia A patients with appropriate Factor VIII (FVIII) values. However, the use of perineural catheters has been poorly documented. We describe a continuous femoral nerve block (CFNB) in conjunction with a sciatic nerve block (SNB) to control perioperative pain in a severe haemophilia A patient undergoing total knee arthroplasty (TKA). Methods We report a case of a 51-year-old man with severe haemophilia A scheduled for TKA. 15 minutes after administering 3000 IU of intravenous recombinant FVIII, a combination of ultrasound-guided SNB and CFNB was performed. The needle was inserted in-plane, from lateral to medial. An initial bolus of 15 mL 0.2% Ropivacaine was injected in each block, followed by an 8 mL/hour continuous femoral nerve perfusion. Afterwards, a total intravenous anaesthesia was required. 2000 IU of recombinant FVIII every 12 hours for the first 3 postoperative days and then every 24 hours were administered. Bemiparin thromboprophylaxis was initiated on the second postoperative day and the femoral catheter was removed on the third without incidents. Results FVIII levels above 100% were maintained throughout admission. No complications from the regional blocks were reported. The score of pain was maintained less than 3 within 72 hours after surgery that facilitated early joint mobilization. Conclusions CFNB may be performed in haemophilia A patients. Nevertheless, it is important to carry out an individualized assessment of the risk-benefit of the technique, a multidisciplinary approach to guide FVIII replacement, and a close follow-up to identify possible bleeding or neurological complications.