Two clinical cases of unintentionally prolonged sciatic nerve block

Abstract

This study describes two clinical cases of unexpectedly long duration of motor block after anterior sciatic nerve block. In two patients who underwent total knee replacement, the motor block reversion in the area of sciatic nerve innervation did not occur at the expected time. Ultrasound examination revealed the deposition of a local anesthetic near the sciatic nerve. In these two clinical cases, unintentionally prolonged sciatic nerve blockade was caused by combined age-related factors of reduced tissue perfusion and the vasoconstrictor properties of levobupivacaine. Subsequently, the block was successfully resolved in 36–38 h without any neurological consequences.

Keywords

сlinical case / levobupivacaine / nerve block / sciatic nerve / ultrasonography / total knee replacement

References

[1] Malchow RJ, Gupta RK, Shi Y, et al. Comprehensive Analysis of 13,897 Consecutive Regional Anesthetics at an Ambulatory Surgery Center. Pain Med. 2018;19(2):368–384. doi: 10.1093/pm/pnx045

[2] Malchow R.J., Gupta R.K., Shi Y., et al. Comprehensive Analysis of 13,897 Consecutive Regional Anesthetics at an Ambulatory Surgery Center // Pain Med. 2018. Vol. 19, N 2. P. 368–384. doi: 10.1093/pm/pnx045

[3] Walker BJ, Long JB, Sathyamoorthy M, et al. Complications in Pediatric Regional Anesthesia: An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network. Anesthesiology. 2018;129(4):721–732. doi: 10.1097/ALN.0000000000002372

[4] Walker B.J., Long J.B., Sathyamoorthy M., et al. Complications in Pediatric Regional Anesthesia: An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network // Anesthesiology. 2018. Vol. 129, N 4. P. 721–732. doi: 10.1097/ALN.0000000000002372

[5] Huo T, Sun L, Min S, et al. Major complications of regional anesthesia in 11 teaching hospitals of China: a prospective survey of 106,569 cases. J Clin Anesth. 2016;31:154–161. doi: 10.1016/j.jclinane.2016.01.022

[6] Huo T., Sun L., Min S., et al. Major complications of regional anesthesia in 11 teaching hospitals of China: a prospective survey of 106,569 cases // J Clin Anesth. 2016. Vol. 31, N. P. 154–161. doi: 10.1016/j.jclinane.2016.01.022

[7] Neal JM, Barrington MJ, Brull R, et al. The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine: Executive Summary 2015. Reg Anesth Pain Med. 2015;40(5):401–430. doi: 10.1097/AAP.0000000000000286

[8] Neal J.M., Barrington M.J., Brull R., et al. The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine: Executive Summary 2015 // Reg Anesth Pain Med. 2015. Vol. 40, N 5. P. 401–430. doi: 10.1097/AAP.0000000000000286

[9] Sondekoppam RV, Tsui BC. Factors Associated With Risk of Neurologic Complications After Peripheral Nerve Blocks: A Systematic Review. Anesth Analg. 2017;124(2):645–660. doi: 10.1213/ANE.0000000000001804

[10] Sondekoppam R.V., Tsui B.C. Factors Associated With Risk of Neurologic Complications After Peripheral Nerve Blocks: A Systematic Review // Anesth Analg. 2017. Vol. 124, N 2. P. 645–660. doi: 10.1213/ANE.0000000000001804

[11] Allegri M, Bugada D, Grossi P, et al. Italian Registry of Complications associated with Regional Anesthesia (RICALOR). An incidence analysis from a prospective clinical survey. Minerva Anestesiol. 2016;82(4):392–402.

[12] Allegri M., Bugada D., Grossi P., et al. Italian Registry of Complications associated with Regional Anesthesia (RICALOR). An incidence analysis from a prospective clinical survey // Minerva Anestesiol. 2016. Vol. 82, N 4. P. 392–402.

[13] Lakhin RE, Tsygankov KA, Doguzov FV, et al. Randomized Evaluation of the Influence of Intravenous Use of Dexamethason on Postoperative Analgesia in Patients after Arthroscopic Operations on the Knee Joint under the Conditions of the Peripheral Regionary Blockade. Regional Anesthesia and Acute Pain Management. 2018;12(3):155–159. doi: 10.18821/1993-6508-2018-12-3-155-159 (In Russ).

[14] Лахин Р.Е., Цыганков К.А., Догузов Ф.В., и др. Рандомизированная оценка влияния внутривенного применения дексаметазона на послеоперационную анальгезию у пациентов после артроскопических операций на коленном суставе в условиях периферической регионарной блокады // Регионарная анестезия и лечение острой боли. 2018. Т. 12, № 3. С. 155–159.

[15] Ovechkin AM, Politov ME, Morozov DV. Neurological Complications of Regional Anesthesia. Regional Anesthesia and Acute Pain Management. 2018;12(1):6–14. doi: 10.18821/1993-6508-2018-12-1-6-14 (In Russ).

[16] Овечкин А.М., Политов М.Е., Морозов Д.В. Неврологические осложнения регионарной анестезии // Регионарная анестезия и лечение острой боли. 2018. Т. 12, № 1. С. 6–14.

[17] Malav K, Singariya G, Mohammed S, et al. Comparison of 0.5% Ropivacaine and 0.5% Levobupivacaine for Sciatic Nerve Block Using Labat Approach in Foot and Ankle Surgery. Turk J Anaesthesiol Reanim. 2018;46(1):15–20. doi: 10.5152/TJAR.2017.03411

[18] Malav K., Singariya G., Mohammed S., et al. Comparison of 0.5% Ropivacaine and 0.5% Levobupivacaine for Sciatic Nerve Block Using Labat Approach in Foot and Ankle Surgery // Turk J Anaesthesiol Reanim. 2018. Vol. 46, N 1. P. 15–20. doi: 10.5152/TJAR.2017.03411

[19] Lirk P, Hollmann MW, Strichartz G. The Science of Local Anesthesia: Basic Research, Clinical Application, and Future Directions. Anesth Analg. 2018;126(4):1381–1392. doi: 10.1213/ANE.0000000000002665

[20] Lirk P., Hollmann M.W., Strichartz G. The Science of Local Anesthesia: Basic Research, Clinical Application, and Future Directions // Anesth Analg. 2018. Vol. 126, N 4. P. 1381–1392. doi: 10.1213/ANE.0000000000002665

[21] Sung HJ, Ok SH, Sohn JY, et al. Vasoconstriction potency induced by aminoamide local anesthetics correlates with lipid solubility. J Biomed Biotechnol. 2012;2012:170958. doi: 10.1155/2012/170958

[22] Sung H.J., Ok S.H., Sohn J.Y., et al. Vasoconstriction potency induced by aminoamide local anesthetics correlates with lipid solubility // J Biomed Biotechnol. 2012. Vol. 2012, N. P. 170958. doi: 10.1155/2012/170958

[23] Bouaziz H, Iohom G, Estebe JP, et al. Effects of levobupivacaine and ropivacaine on rat sciatic nerve blood flow. Br J Anaesth. 2005;95(5):696–700. doi: 10.1093/bja/aei242

[24] Bouaziz H., Iohom G., Estebe J.P., et al. Effects of levobupivacaine and ropivacaine on rat sciatic nerve blood flow // Br J Anaesth. 2005. Vol. 95, N 5. P. 696–700. doi: 10.1093/bja/aei242

RIGHTS & PERMISSIONS

Eco-Vector