A54-02 Balancing Analgesia and Respiratory Management in Guillain-Barré Syndrome: A Case Report

Abstract Introduction Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy primarily characterized by progressive weakness and areflexia. Respiratory failure is a well-known critical complication requiring intensive care. However, managing severe neuropathic pain with analgesia while preserving respiratory function presents an underappreciated clinical challenge. Effective pain control is essential for recovery but must be balanced against risks of respiratory depression, particularly when using opioids. Case Report A 71-year-old woman with bilateral hip replacements presented with acute bilateral thigh pain followed by progressive lower extremity weakness and inability to ambulate. Neurologic exam revealed symmetric weakness, diminished reflexes, and sensory deficits. Given concern for GBS and possible respiratory compromise, she was admitted to the neuro-ICU.Lumbar MRI demonstrated patchy nerve root enhancement. CSF analysis was normal without albuminocytologic dissociation. Autoimmune testing showed strongly positive anti-GM1 and GD1a antibodies. She completed a 5-day intravenous immunoglobulin (IVIg) regimen.Her hospital course was complicated by severe neuropathic pain, mainly in the left lower extremity. Multimodal analgesia included acetaminophen, gabapentin, duloxetine, baclofen, lidocaine patches, and PRN morphine. Despite these measures, persistent pain led to increased opioid use, resulting in oversedation with intermittent apnea. One oversedation episode produced new right upper extremity weakness, triggering a stroke alert; neuroimaging was negative.Following cautious titration of duloxetine and gabapentin, reintroduction of baclofen, and minimization of opioids, pain improved without further respiratory compromise. The patient remained hemodynamically stable, avoided intubation, and was discharged to acute rehabilitation on a stable multimodal pain regimen. Discussion This case underscores the complexity of balancing effective analgesia with respiratory safety in GBS critical care. While respiratory failure often dominates clinical focus, severe neuropathic pain can significantly impact outcomes and complicate care. Opioid-induced respiratory depression and oversedation may mimic new neurologic events, confounding assessment and management.A multidisciplinary approach involving neurology, pain management, anesthesia, and critical care is vital to optimize analgesia without compromising respiratory function. Early recognition and opioid-sparing multimodal strategies can facilitate safer pain control, improve functional recovery, and support timely rehabilitation.*Generative artificial intelligence assisted with the preparation of this abstract* This abstract is funded by: None