Anesthesia Considerations for Transfemoral Osseointegration in a Patient With CRPS, Propofol, and Ketamine Allergies: A Case Report.

A 20-year-old female with asthma, Ehlers-Danlos syndrome, Hashimoto's thyroiditis, mast cell activation syndrome, and complex regional pain syndrome Type 1 (CRPS1) presented for left transfemoral amputation with osseointegration and nerve reconstruction. To limit CRPS1 exacerbation, neuraxial anesthesia with femoral and sciatic blocks was administered for analgesia. Given the reported history of convulsions following ketamine and propofol, sedation with midazolam, dexmedetomidine, and fentanyl was used. On POD 1, fascia iliaca and sciatic blocks were repeated to mitigate postoperative pain. There were no intraoperative or postoperative complications. With limited literature on anesthesia for osseointegration, this novel case highlights individualized planning, in the setting of adverse responses to anesthetic medications and challenging pain management.