Anaesthesia for Mitrofanoff Procedure in a young male patient with exstrophy-epispadias complex

Purpose: One of the most challenging tasks of an anaesthesiologist is intraoperative and postoperative pain management. The exstrophy-epispadias complex is a congenital distortion not only of the genito­urinary system but also the muscles of the wall of the abdomen and structures of the pelvis. The focus of surgical repair remains on bladder reconstruction and its surrounding structures with cosmesis and a better quality of life.

Features: A twenty-year-old male, known case of exstrophy-epispadias complex, presented for Mitrofanoff repair for recurrent urinary tract infections. This case report highlights the use of lumbar epidural infusion of local anaesthetic bupivacaine and opioid fentanyl with general anaesthesia for Mitrofanoff procedure in urinary bladder exstrophy-epispadias surgery.

Conclusion: Regional anaesthesia along with general anaesthesia has advantages such as decreased use of anaesthetic drugs intraoperatively, better haemodynamics, effective analgesia both intraoperatively and postoperatively. Although there have been differences in opinion on the usage of opioids in epidurals, it has been shown to facilitate early gastric motility, better analgesia and better recovery profiles.