Transverse abdominis plane block for surgical anesthesia in a patient with flail arm syndrome

摘要

Flail arm syndrome (FAS), also known as ‘man-in-the-barrel’ syndrome or brachial amyotrophic diplegia, is an atypical presentation of amyotrophic lateral sclerosis (ALS). It is differentiated from ALS by lower motor neuron type proximal muscle weakness of only the upper limbs. The lower limbs may show mild upper motor neuron type weakness, but the bulbar and respiratory muscles are not affected. It has a progressive course with a male-to-female ratio of 4 : 1 [ ]. FAS is one of the spectra of motor neuron disease (MND) and shares many of the pathophysiological features of MND. MND is a degenerative disease of the spinal cord tracts and leads to respiratory muscle atrophy due to the ongoing, chronic process of denervation and re-innervation of muscles.