Anesthetic management of a patient with congenital insensitivity to pain: a case report.

Pain protects the body from damaging effects of harmful stimuli. Congenital insensitivity to pain is a rare inherited disorder characterized by diminished or absent sensitivity to pain, touch, and pressure that leads to frequent trauma and self-mutilation. The disorder is part of the hereditary sensory and autonomic neuropathy (HSAN) family, in which 5 types have been recognized. Research and case reports of anesthetic risks and analgesic needs of these patients is limited due to the infrequent nature of the disorder. Recommendations for anesthesia include modification of intraoperative opioid requirements, use of anesthetics to ensure cooperation and immobility, and intraoperative temperature monitoring. It is imperative for anesthesia providers to understand which type of HSAN their patient experiences and to conduct a thorough preoperative interview because a different interpretation of sensory loss may occur in each HSAN category. This article reports the case of a patient with HSAN type 2 who presented for knee arthroscopy.