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Anesthesia

Severe joint pain,swelling after appendectomy

08/10/2006

Question:

I recently had a TAH/BSO 6 weeks ago. After a hard two week recovery we discovered I had appendicitis so an appendectomy was done. I had no muscle or joint complications after the first surgery and am in very good physical condition at 37. About 36 hours after the appendectomy I woke up unable to move. The pressure in my joints and stiffness was incredible. Several calls were placed and I was told by my surgeon that several of his patients has a "virus" post-surgery in the same time period. I have since seen a rheumatologist and was told that I might have "inflammatory arthritis". I am very confused and would like your opinion on whether this is a very lingering viral infection such as parvovirus or if it is a lingering effect to an anesthetic I was given in the second surgery or if at 37 years old and with no family history of arthritis if it is possible at all that I could develop it so suddenly. Lab work revealed a 5.85 marker for IgG in Parvovirus but a normal IgM,also all other "arthritis markers" were normal, however SED rate was increased as well as C-reactive protein. Any help, advice, or referral would be greatly appreciated. Thank you

Answer:

The only condition that there is even a small chance of being caused by your anesthesia is the syndrome of postoperative myalgia (muscle pain) associated with the muscle relaxant (paralyzing drug) called succinylcholine. If you had emergency surgery for appendicitis it is very possible that this otherwise excellent muscle relaxing agent was used to allow the breathing tube to be placed. The muscle pain you get from this drug occurs most often in young women undergoing outpatient surgery. It is self-limited - that is, it goes away without specific treatment over a two to three days. In some cases it may last as long as a week.

It is difficult for me to offer any additional explanations over the ones you have so far been given. I think it is safe to say however that if your problems are persistent they are not due to the two anesthetics you received. Your sed rate would not be elevated. I hope that you recover soon.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University