nail surgery in MS patient

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I would be greateful for any advice anyone might have. We have a patient with Multiple Sclerosis who we are considering doing nail surgery on. She has uncontrollable triggering of both first toes which has lead to hyper extension which in turn has lead to her toes / nails rubbing on her footwear. The nails have pincer involution and although she manages them fairly well with a file they do give discomfort.
My query is:
Would a local anaesthetic negatively affect the existing nerve fibres?
Would giving a local anaesthetic supress or halt the tremors?
Is healing time affected in patients with MS?
Would we be better off doing an ankle block?

Any advice would be gratefully recieved.
Thanks very much.

 

i) L.A. solutions should not adversely affect the nerve fibres at the level of the digital nerves:
ii) At this level it will not suppress or halt the tremors
iii) I cannot find any reference to suggest healing time will be affected, but obviously this depends on the severity of the condition
iv) since the tremor usually occurs from demylenation at spinal level, an ankle block will probably not help and might be difficult is there is a tremor present

As in so may cases, it's a matter of clinical judgement precisely what you do. I would certainly liaise with the relevant specialist and be careful of post-operative infection.

All the best

Bill Liggins

 

Hi I avulsed a nail on an MS pt a couple of years ago, a normal toe block, I just had to prepare myself for the strong reflex once the needle pierced the skin. There wasn't any further reflex once the toe was anaesthetised. No phenol was applied and the toe healed normally.

Hope this helps

Best wishes

Nina Neal

 

Hi! Having performed nail surgery on several MS patients there were no problems that could not be overcome! Phenol was used and they did heal within the normal time scales.
One tip though, I inject from the plantar aspect so when the toe goes into spasm you move with it as opposed to against it.
Good luck with your procedure, not that you need luck; skill and confidence are better.

 

I've also removed both 1st nails off a patient wit MS. No issues, except that the healing time took a fraction longer than expected, the patient's trigger hallux rubbed on the toe box of the shoes. once he was put in open toe shoes no issues.