Reactions 978 - 22 Nov 2003

SRopivacaine

Sciatic nerve palsy following lumbar plexus block:case report

A 30-year-old man with a history of congenital hip dysplasiadeveloped sciatic nerve palsy while receiving continuouslumbar plexus blockade with ropivacaine following left totalhip arthroplasty.

The man received an injection of 30mL of ropivacaine 0.5%in 5mL increments into his lumbar plexus, followed bycatheter insertion for continuous local anaesthetic infusion,before undergoing uneventful total hip arthroplasty undergeneral anaesthesia. A continuous infusion of 0.2%ropivacaine 8 mL/h through the lumbar plexus catheter wasstarted postoperatively and the following morning he receivedenoxaparin sodium. Approximately 3 hours later, hecomplained of severe hip pain and patient-controlledanalgesia, which had been discontinued, was reinstated.However, an hour later he also complained of diminishedsensory and motor function below his left knee, whichprogressed to complete loss over 30 minutes. An examinationconfirmed profound loss of sensory and motor function in thedistribution of his tibial and common peroneal nerves, withdiminished sensation over obturator, femoral and lateralfemoral nerve distributions.

The man’s lumbar plexus block was discontinued to aidfurther neurological examination. A CT scan revealed ahaematoma in his hip with compression of the sciatic nerveand he was subsequently returned to the operating room forevacuation of a 300mL haematoma. Postoperatively, heshowed marked improvement in both sensory and motorfunction, and 48 hours later had nearly complete resolution ofhis sensory and motor deficits, with only mild weakness in hisability to fan out his toes.Ben-David B, et al. Sciatic nerve palsy after total hip arthroplasty in a patientreceiving continuous lumbar plexus block. Anesthesia and Analgesia 97:1180-1182, No. 4, Oct 2003 - USA 800962082

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Reactions 22 Nov 2003 No. 9780114-9954/10/0978-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved