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A 60-year-old patient suffering from pemphigus vulgaris for the past year was admitted to the emergency ward for fracture neck of femur. She also presented with lesions involving oral mucosa, back, inframammary and genital areas which were in partial remission. In hospital she was diagnosed with hypertension and was put on anti-hypertensives. Special attention was paid during positioning for surgery, administration of regional anaesthesia and placement of the intravenous line as well as monitoring devices. General anaesthesia was avoided in the presence of partially active oral lesions. Combined spinal-epidural anaesthesia was administered using bupivacaine-clonidine mixture. No haemodynamic complication was observed with 30 μg of clonidine intrathecally and no skin lesion occurred at the site of injections or Tegaderm application.

Case study: Anaesthesia implications and considerations in a case of pemphigus vulgaris for orthopaedic bipolar prosthesis implant surgery