# Real-time ultrasound-guided sacral plexus block combined with mild sedation for hemorrhoidectomy and hemorrhoidal artery ligation in a patient with amyotrophic lateral sclerosis: a case report

## TL;DR

A safe anesthesia method using ultrasound guidance and mild sedation was successfully used for a patient with amyotrophic lateral sclerosis undergoing hemorrhoid surgery.

## Contribution

A novel anesthetic approach combining real-time ultrasound-guided sacral plexus block and mild sedation is proposed for amyotrophic lateral sclerosis patients.

## Key findings

- The anesthesia method met surgical demands without respiratory complications.
- No neurological deterioration was observed post-surgery or three months later.
- The technique proved effective and safe for the patient's condition.

## Abstract

Patients with amyotrophic lateral sclerosis present perioperative challenges for clinical anesthesiologists for anesthesia-associated complications.

A 54-year-old Han woman with a 2-year history of amyotrophic lateral sclerosis was scheduled for hemorrhoidectomy and hemorrhoidal artery ligation. We performed real-time ultrasound-guided sacral plexus block with dexmedetomidine under standard monitoring. The anesthesia method met the surgical demands and avoided respiratory complications during the procedures. There was no neurological deterioration after the surgery and 3 months after, the patient was discharged.

Real-time ultrasound-guided sacral plexus block combined with mild sedation may be an effective and safe technique in patients with amyotrophic lateral sclerosis undergoing hemorrhoidectomy and hemorrhoidal artery ligation.