Guillain-Barré Syndrome (GBS) or Acute Inflammatory Demyelinating Polyneuropathy (AIDP) is a rare autoimmune disorder (CDC estimates that there are between 3000-6000 cases per year) of the peripheral nervous system which manifests itself as bilateral weakness and tingling in the hands and feet. It is thought that the body’s immune system, while fighting off this initial infection, begins to attack healthy nervous tissue resulting in an acute demyelination of the peripheral nervous system.
•Symptoms may progress to the arms and upper body resulting in an “ascending paralysis”.
•Two-thirds of patients experience some sort of preceding symptomatic infection (most commonly gastrointestinal from C. Jejuni).
•Many fear that a regional technique may predispose patients to worsening neurological symptoms or recrudescence.
This was an observational, retrospective chart review performed at a single-center, and was approved by the IRB at Hospital for Special Surgery. All the data was collected through a review of medical records.
•Descriptive statistics for cohort demographics included age, body mass index, gender, race, ethnicity, and ASA. Continuous variables were reported as median and interquartile range, and categorical variables were reported as frequencies and percentage. All statistical analyses were conducted using SAS version 9.4 (SAS Institute, Cary, NC)."
•The primary outcome was any change in neurological exam post-operatively, length of stay in the PACU, and length of stay in the hospital. Secondary data included time to completing physical therapy milestones and PONV.
“Of the 18 patients who received general anesthesia and the 85 patients who received neuraxial anesthesia, there was no appreciable difference between the groups in terms of neurological outcomes, length of PACU stay, or length of hospital stay”
•We identified 166 patients with a history of GBS who underwent surgery at HSS between 2014-2023 utilizing EPIC EMRs.
•63 patients underwent spine or upper extremity surgery.
•103 patients who underwent some type of lower extremity orthopedic procedure.
•18 patients had general anesthesia
•79 patients had spinal or combined spinal/epidural anesthesia
•5 had MAC anesthesia
•1 had a peripheral nerve block as the primary form of anesthesia.
•67 peripheral nerve blocks were administered for post-operative pain.
•There was no appreciable difference between the groups in terms of neurological outcomes, length of PACU stay, or length of hospital stay.
•There was no appreciable difference between the groups in terms of time to achieving Physical Therapy milestones or incidence of post-operative nausea and vomiting which required pharmacological treatment.
•A causal link between neuraxial anesthesia and worsening of GBS has never been established, save a few case reports; most of the literature on this subject matter has come from the obstetrical anesthesia literature.
•In this observational, retrospective chart review, a history of GBS did not preclude the use of spinal anesthesia, and in fact, there were no appreciable differences in outcomes in patients with this history undergoing lower extremity orthopedic surgery when given general or spinal anesthesia.
•This is a very small volume of cases in a single center where the surgical volume is typically over 35,000 annually of which 85% of cases are done with a regional anesthetic technique. We looked at all lower extremity surgical cases from all services (arthroplasty, sports, foot and ankle, trauma, limb lengthening) that were both ambulatory and inpatient
