Anesthetic management for tendon transfer in a patient with monomelic amyotrophy (Hirayama Disease): A case report

Abstract

Hirayama disease is a rare cervical myelopathy characterized by dynamic compression of the spinal cord during neck flexion, presenting unique challenges for anesthetic management. This case report describes the successful use of a supraclavicular brachial plexus block for tendon transfer surgery in a patient with Hirayama disease (HD).

A 34-year-old male with a 10-year history of progressive left hand weakness and atrophy, diagnosed with HD, was scheduled for tendon transfer surgery to improve hand function. Given concerns about cervical spine manipulation and potential cord compression with general anesthesia, a supraclavicular brachial plexus block was selected as the primary anesthetic technique. Ultrasound-guided block was performed using a combination of 0.75% ropivacaine 15mL and 2% lidocaine 10 mL, and 8mg of dexamethasone given achieving complete sensory and motor blockade within 12 min. The patient maintained a comfortable neutral neck position throughout the procedure. Surgery proceeded uneventfully with excellent surgical conditions and hemodynamic stability. Postoperatively, the patient reported minimal pain (VAS score 2/10) requiring only acetaminophen for the first 24 hours, expressed high satisfaction with the anesthetic technique, and was discharged on the second postoperative day without complications.

Conclusion: Supraclavicular brachial plexus block represents an effective and safe anesthetic technique for patients with HD undergoing upper limb procedures, avoiding risks associated with neck manipulation during general anesthesia while providing excellent surgical conditions and postoperative pain control. This approach should be considered as a primary option for appropriate surgeries in this patient population.

Abbreviations: BMI: Body Mass Index, HD: Hirayama Disease, VAS: Visual Analog Scale,

Keywords: Hirayama Disease; USG Guided; Supraclavicular Brachial Plexus Block; Tendon Transfer

Citation: Shah B, Pramanik P. Anesthetic management for tendon transfer in a patient with monomelic amyotrophy (Hirayama Disease): A case report. Anaesth. pain intensive care 2025;29(5):428-432. DOI: 10.35975/apic.v29i5.2864

Received: April 10, 2025; Revised: May 07, 2025; Accepted: May 09, 2025