Reactions 1152 - 19 May 2007

SBupivacaine

Sciatic nerve injury following inadvertentintraneural injection: case report

A 46-year-old man developed sciatic nerve injury followinginadvertent intraneural injection of bupivacaine.

The man underwent left total hip replacement under generalanaesthesia; additionally, 25mL of 1% bupivacaine wereinjected for lumbar plexus block, and sacral plexus block wasperformed by injection of 15mL of 1% bupivacaine via aposterior approach. After exposure of the hip, the sciatic nervewas found to be distended with local anaesthetic leaking fromthe sheath. At the end of surgery, the nerve appeared relaxedin extension, but was under slight tension at 90° of flexion.After surgery, he developed urinary retention, right lower limbweakness and two or three episodes of visual disturbance.Within 24 hours, right limb weakness resolved; urinaryretention settled over the following 5 days. Plexus blockpersisted for 48 hours. After its resolution, he experienced leftfoot-drop and persistent pain along the sciatic nerve. After2 weeks, the hip was re-explored and the sciatic nerve wasexposed from the sciatic notch to the proximal thigh. Noevidence of neurotmesis was found, and the nerve was relaxedin extension and under slight tension at the limit of flexion.Electromyography indicated severe axonal loss in the sciaticnerve with only slight response from the posterior tibial nerveand no response from the common peroneal nerve.

The man was mobilised in a foot-drop splint and referred toa specialist. he recovered substantial motor function over thenext 5 years, but chronic pain persisted despitepharmacological therapy.

Author comment: "In our case routine intra-operativeexposure of the sciatic nerve allowed the diagnosis ofintraneural injection to be made."Uppal HS, et al. Sciatic nerve injury caused by pre-operative intraneural injectionof local anaesthetic during total hip replacement. Journal of Bone and JointSurgery - British Volume 89B: 242-243, No. 2, Feb 2007 - UnitedKingdom 801073322

1

Reactions 19 May 2007 No. 11520114-9954/10/1152-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved