Reactions 1156 - 16 Jun 2007

SBupivacaine

Femoral nerve paralysis: case reportA 63-year-old man developed femoral nerve paralysis during

an ilio-inguinal block for a right inguinal hernia repair.The man received induction of general anaesthesia followed

by injection of 0.5% plain bupivacaine 20mL at a point inferiorand medial to his right anterior superior iliac spine. Gentlepressure was applied to the injection site to encourage thebupivacaine to spread towards the ilio-inguinal nerve.Following an uneventful operation, he was transferred to aday-case unit and, 4 hours later, he could not weight-bear andwas not discharged home. Examination revealed a densemotor paresis in his right quadriceps muscle and weak kneeextension and hip flexion. There was an area of anaesthesiaover the inner region of his left thigh (L1 to L3 dermatomes).He was diagnosed with right femoral nerve paralysis.

The man was admitted overnight for observation, duringwhich time regular improvements in his motor power werenoted, with complete recovery after 36 hours.

Author comment: "We believe that the relatively largevolume of the higher concentration of 0.5% bupivacaine,together with the pressure applied superior to the injectionpoint, had contributed to the dense and prolonged block."Salib Y, et al. Prolonged femoral nerve palsy after ilio-inguinal nerve block.Regional Anesthesia and Pain Medicine 32: 271, No. 3, May-Jun 2007 -England 801071738

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Reactions 16 Jun 2007 No. 11560114-9954/10/1156-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved