Anesthetic Management of a Child with Congenital Insensitivity to Pain for Excision of Supraorbital Bony Swelling

A 3-year-old child presented with insidious onset gradually progressive swelling in the supraorbital region. The mother gives a history of the child not perceiving pain during immunization, recurrent lip bites, and repeated trauma in various parts of the body. He was evaluated in detail and diagnosed with congenital insensitivity to pain (CIP). We present the case of this child with CIP who underwent excision of supraorbital bony swelling. Individuals with this rare genetic entity require frequent hospitalization and pose various perioperative challenges. Apart from this, they present with varying degrees of autonomic dysfunction and intellectual disability. We report the conduct of anesthesia for excision of supraorbital swelling and perioperative problems. Minimal amount of opioids was given to blunt the intubation response. He did not require additional analgesia intraoperatively and on follow-up. We would like to highlight the use of objective means of monitoring nociception to understand the complexity.