Epidural block with catheter placement was effective in pain relief of severe skin erosion in a patient with congenital dominant dystrophic epidermolysis bullosa: a case report

Abstract

Epidermolysis bullosa hereditaria is an inherited, intractable disease in which blisters and erosions form on the skin in response to small external forces. This case report describes pain management for painful procedures in a 60-year-old man with dominant dystrophic epidermolysis bullosa who fell down a flight of stairs and developed extensive erosions. Although analgesia with opioid analgesics or ketamine were considered options, complications such as nausea and respiratory depression were feared to be potentially unmanageable due to lack of time for anesthesiologists to respond appropriately. Therefore, a pain management plan was implemented in which the epidural block was managed by a dermatologist using an epidural tube placed by an anesthesiologist. This approach successfully reduced the pain during treatment while ensuring patient safety. Notably, meticulous securing of the epidural catheter allowed for management without inciting additional skin lesions.