2005 Volume 12 Issue 2 Pages 98-100
Nerve block for a patient with a bleeding disorder should be performed with caution due to the risks of bleeding and hematoma formation. We report a case of successful management of lumbar sympathetic ganglion block for a patient with von Willebrand's disease.
A 68-year-old man with von Willebrand's disease consulted our pain clinic complaining of pain and numbness in lower limbs due to spinal canal stenosis. Because conservative therapies were not effective, the patient consented to undergo a lumbar sympathetic ganglion block after being informed about possible complications.
Supplementary therapy with coagulation factors (combined factor VIII and vW factor concentrate) was planned to maintain coagulability during the nerve block. A pilot study was performed prior to the block to investigate the pharmacokinetics of the coagulation factors. The pilot study revealed that, administration of 5, 000IU of combined factor VIII-vW factor concentrate induced adequate coagulability within one hour, and this effect continued for 6 hours. One hour before the block, 5, 000IU of combined factor VIII-vW factor concentrate was administered, and right-sided lumbar sympathetic ganglion block was performed under radiographic control. After the block, three further doses of 5, 000IU of combined factor VIII-vW factor concentrate were administered at 6 hourly intervals. The patient's recovery was uneventful and he was discharged one day after the block without major complaints.
The present case showed that the lumbar sympathetic ganglion block is feasible for a patient with von Willebrand's disease using supplementary therapy with coagulation factors.
