Familial Mediterranean Fever (FMF) is a rare hereditary condition characterized by recurrent episodes of painful inflammation.  These pain episodes occur most commonly in the abdomen, and can be accompanied by fever, rash, and headaches.  They are usually triggered by an event such as emotional stress.  FMF predominantly affects people of Armenian, Arab, Turkish, or Jewish descent from the Mediterranean region with a prevalence of 1 in 200 to 1,000 people. We present a case of a 53-year-old female with FMF who underwent regional anesthesia for podiatry surgery (bunionectomy). This patient’s FMF symptoms of fever and serositis were triggered by stress and anxiety, but were controlled for the past six months on outpatient oral colchicine therapy.  On the day of surgery, patient took her home colchicine medication, as instructed.  In the operating room, patient was given midazolam for anxiolysis and fentanyl for pain control prior to the performance of a left ankle peripheral nerve block.  All five peripheral nerves of the ankle were identified by anatomic landmarks.  Local anesthetic solution of ropivacaine 0.5% and lidocaine 1% mixture was used.  Padded ankle tourniquet was used to maximize patient comfort.  Intravenous propofol was titrated to patient’s level of sedation during the surgery.  The nerve block and surgery were both uneventful, and patient was later discharged home.  Anesthetic goals for FMF patients should focus on stress and anxiety reduction, and the prevention of acute attacks. Careful consideration of each patient’s needs is important in providing high quality and safe anesthesia care.

Authors:

1. Calvin Wong, B.S.  UCLA David Geffen School of Medicine. 4th year Medical Student. E-mail: CWWong@mednet.ucla.edu. 
2. Elizabeth Tsai, M.D.  Assistant Clinical Professor of Anesthesiology at UCLA David Geffen School of Medicine.  Department of Anesthesiology at Olive View UCLA Medical Center.
3. Fei Zheng-Ward, M.D. Assistant Clinical Professor of Anesthesiology at UCLA David Geffen School of Medicine.  Department of Anesthesiology at Olive View UCLA Medical Center.
4. Diana Phan, M.D. Assistant Clinical Professor of Anesthesiology at UCLA David Geffen School of Medicine.  Department of Anesthesiology at Olive View UCLA Medical Center.