Two clinical cases of unintentionally prolonged sciatic nerve block

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

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.

Full Text

Restricted Access

About the authors

Vasiliy G. Tsvetkov

S. M. Kirov Military Medical Academy

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0003-4980-597X
Russian Federation, 6, st. Akademika Lebedeva, St. Petersburg, 194044

Roman E. Lakhin

S. M. Kirov Military Medical Academy

Author for correspondence.
Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0001-6431-439X

MD, PhD, DSc, professor

Russian Federation, 6, st. Akademika Lebedeva, St. Petersburg, 194044

Anatoliy V. Stukalov

S. M. Kirov Military Medical Academy

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0002-3869-9043
Russian Federation, 6, st. Akademika Lebedeva, St. Petersburg, 194044

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. 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
  3. 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
  4. 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
  5. 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
  6. 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.
  7. 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).
  8. 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).
  9. 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
  10. 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
  11. 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
  12. 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

Supplementary files

Supplementary Files
Action
1. Fig. 1. Sciatic nerve block by anteromedial access. A – scheme of the blockade. Б – Sonogram of the blockade (Сед – sciatic nerve)

Download (504KB)
2. Fig. 2. Ultrasound examination from the back of the thigh. A – Scan 18 hours after the blockade. Б – 26 hours after the blockade (Сед – sciatic nerve, MA – local anesthetic)

Download (272KB)

Copyright (c) 2021 Eco-Vector



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies