術後に再発を認めた多発性硬化症患者の1症例

A Case of Postoperative Multiple Sclerosis Relapse

要旨

　55歳，男性，10年間寛解期であった多発性硬化症（multiple sclerosis：MS）患者に対して全身麻酔下で開腹膵頭十二指腸切除術を施行した。MSの再発を懸念して区域麻酔は施行しなかったが，術翌日に下肢の運動障害が出現し，精査の結果，MSの再発と診断した。MSが周術期に容易に再発することを考慮し，慎重な麻酔方法の選択と患者への説明が重要であると考えられた。

　Multiple sclerosis（MS）is a demyelinating neuroinflammatory disease of the central nervous system with variable course, showing relapses and remissions. Perioperative stress is one of the factors that can trigger MS relapse. Although regional anesthesia（RA）improves intraoperative pain relief, the evidence concerning the risks of RA in patients with MS is unclear. Herein, we report a case of MS relapse after surgery. A 55-year-old man was scheduled for open abdominal pancreatoduodenectomy under general anesthesia. Considering the possibility of MS neurological deterioration, RA was not performed. Although he uneventfully underwent pancreatoduodenectomy and no significant pain was observed under continuous administration of dexmedetomidine and fentanyl, the patient experienced MS relapse the day after the operation. Surgical stress was suspected as a potential cause of MS relapse. Thus, in the perioperative management of patients with MS, we should carefully inform patients about potential relapse and whether to utilize RA.