CR1-179
The Use of Acupuncture in a Patient with Mucolipidosis Type II to Alter the Course of Surgical Planning
Bhakta A, Reece-Stremtan S
Children's National Medical Center, WASHINGTON, District o, United states
INTRODUCTION: Acupuncture is a complementary therapy that is being used increasingly in a multi-modal approach to pain management. Despite minimal contraindications and an excellent safety profile, skepticism still exists around the efficacy of acupuncture. We present a novel case in which the use of palliative acupuncture was used to avoid surgical intervention for severe cervical spine stenosis in a medically complex patient.
CASE REPORT: 23 yo with history of mucolipidosis type II, skeletal dysplasia, hypotonia, and severe cervical spinal stenosis with myelomalacia presented to our anesthesiology preoperative clinic in preparation for a cervical spine decompression. Patient’s medical history complicated by hypertrophic cardiomyopathy, severe aortic insufficiency, OSA on BiPAP, chronic lung disease, and a history of reported difficult bag mask ventilation and difficult intubation. After a multi-disciplinary discussion with anesthesiology, neurosurgery, and ENT, it was determined that the safest surgical course would involve a prophylactic tracheostomy with subsequent cervical decompression after a period of tracheostomy healing. It was also discussed with family that the proposed surgical plan would carry significant risk of complications and morbidity if patient were to undergo a general anesthetic. Regarding patient’s chronic neck, chest wall, and knee pain, he had multiple failed management strategies in the pain clinic secondary to adverse effects and intolerance of medications. In an effort to avoid surgery due to the risk profile, the patient was then referred to an acupuncture specialist to maximize conservative therapy prior to re-addressing the surgical option. Patient has now continued weekly acupuncture for >1 year with >50% improvement in pain scores with improvement in ability to perform ADL/IADL. Surgical intervention has been avoided in this patient and is currently managed conservatively with surveillance cervical spine imaging and routine follow-up.
DISCUSSION: Acupuncture has been well described and practiced for centuries as a modality for treatment of acute and chronic pain and many other conditions. For elective surgical procedures in medically complex patients, a full preoperative risk/benefit evaluation is critical in determining what is the safest course of action for the patient. General anesthesia can pose significant risk of morbidity in patients with comorbid conditions such as a difficult airway, significant cardiac pathology, and poor pulmonary capacity. When patients are identified in which risks may outweigh the benefit of the proposed surgical intervention, a multi-disciplinary approach should be taken to optimize conservative options. We propose a strong consideration for implementing acupuncture therapy within an integrated care plan for these high-risk patients. This is especially true when conventional standard of care is not effective, not acceptable to the patient, or has intolerable side effects.
REFERENCES: 1) Melzack R. (1976). Anaesthesist. 25:204-7. 2) Wilkinson, J. (2007). BJA Education: Continuing Education in Anaesthesia Critical Care and Pain. 7(4):135-8. 3) White P., et. al. (2004). Ann Intern Med. 141:911-9. 4) Kapthuk TJ. (2002). Ann Intern Med. 136:374-82.
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