247: Pain Management in Patient with Hypertrophic Non-Obstructive Cardiomyopathy in an Orthopedic Surgery

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic posttraumatic pain, Pharmacological treatments, Treatment/management

Background and Aims: Pain management and anaesthesia in patients with pre-existing cardiac conditions presents significant challenges.¹ Hypertrophic cardiomyopathy (HOCM) is a myocyte disease causing increased left ventricular wall thickness and may lead to left ventricular outflow obstruction , arrhythmias etc.² Anaesthesia in HOCM cases should aim to maintain good pain management & cardiac output, control heart rate and minimize excessive sympathetic tone.³
We discuss perioperative Pain management of a patient with HOCM undergoing Anterior Cruciate Ligament reconstruction with Medial Meniscus repair.

Methods: A 35 y old male presented with Left Anterior Cruciate Ligament tear and pain over the knee since 2-3 weeks . An ACL Repair with Medial Meniscus Repair was planned. Patient presented for pain management following surgery. Contrast-Enhanced MRI was suggestive of Hypetrophic Cardiomyopathy (Non Obstructive). Echocardiography showed concentric Left ventricular hypertrophy with Interventricular Septum thickness 19mm. Low dose spinal anesthesia i.e 0.5% Bupivacaine(1.4 ml) with 10µg Fentanyl was injected at L3-L4 level. Vitals were monitored.An adductor canal block was performed (30ml of 0.25% Bupivacaine) for analgesia. VAS scores were measured uptil 48h post procedure.

Results: There was a progressive reduction in pain, measured by Visual Analogue Scale (VAS) following adductor canal block. (Preoperative VAS score of 6 to VAS score of 2 at 48h post procedure). Patient also reported a reduction in dosage of analgesics in the days following the post procedure period.
SpO2, Mean Arterial Pressure and Heart rate were monitored upto 48 hrs and were documented as stable.

Conclusions: We used low-dose spinal anaesthesia so as to minimise the risk of any hemodynamic fluctuations. It was followed by an adductor canal block for an effective, prolonged postoperative pain relief. Therefore, administration of appropriate anaesthesia technique along with a vigilant intraoperative monitoring and pain relief is required in HOCM cases posted for surgical procedures for an uneventful outcome as well as avoidance of complications.

References: 1.Kaul Tej K., Tayal G. Anaesthetic Considerations in Cardiac Patients Undergoing Non Cardiac Surgery. Indian Journal of Anaesthesia 51(4): 280-286.

2.Pantazis A, Vischer AS, Perez-Tome MC, Castelletti S. Diagnosis and management of hypertrophic cardiomyopathy. Echo Res Pract. 2015;2(1):45-53. doi: 10.1530/ERP-15-0007.

3.Juneja R, Nambiar PM. Cardiomyopathies and anaesthesia. Indian J Anaesth. 2017;61(9):728-735. doi: 10.4103/ija.IJA_385_17.

Presenting Author: Dr Sunil
Submitting Author: SUNIL SUNIL

Senior Author: Dr Deepa K Khurana

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Dr Deepa K Khurana: MD Anesthesia - Vardhman Mahavir Medical College
• Dr Dimple Pande: MD, DNB Anesthesia - Vardhman Mahavir Medical College
• Dr Kavita Rani Sharma: MD Anesthesia - Vardhman Mahavir Medical College