Ropivacaine induced brachial plexus neurotoxicity- A case report

Vol 6 | Issue 3 | September-December 2020 | Page  | Shailesh Murty, Kanishk Murty


Author: Shailesh Murty [1], Kanishk Murty [2]

[1] Department of Anaesthesia, Wangaratta private hospital, Victoria, Australia.
[2] Department of Biomedical Sciences, Faculty of Health Sciences and Medicine,
Bond University, Robina, QLD 4226, Australia.
Address of Correspondence
Dr. Shailesh Murty,
Senior Consultant Anaesthetist, Department of Anaesthesia, Wangaratta private
hospital, Victoria, Australia.
E-mail: sleep3124@gmail.com


Ropivacaine induced brachial plexus neurotoxicity- A case report


Abstract

Background: Neurotoxicity of the nerves has been reported to be related to the concentration or volume of local anaesthetic used. We report a case wherein the volume and concentration of local anaesthetic used was well within the safe limits. Despite the safe precautions taken, the patient developed a profound motor and sensory block which took nearly 20 weeks to resolve.
Case presentation: A 72-year-old female patient scheduled for a total shoulder arthroplasty received a single shot interscalene block under ultrasound guidance. A total volume of 10mls of ropivacaine 0.375% was injected under direct ultrasound guidance. The patient experienced no pain on injection and neither was there any paraesthesia on needle placement. We encountered no high pressures during the injection. The patient had a profound block which lasted for over 20 weeks. The patient was followed up at regular intervals which showed a slow recovery pattern.
Conclusion: Local anaesthetics are known to cause neurotoxicity. This case highlights the need to be mindful about potential sequelae to nerve blocks despite using a lower concentration and volume of local anaesthetic.

Key Words: Interscalene block; Neurotoxicity; Ropivacaine.


References

1. Brull R., McCartney C.J., Chan V.W., El-Beheiry H. Neurological complications after regional anesthesia: Contemporary estimates of risk. Anesth. Analg. 2007;104:965–974
2. Barrington M.J., Watts S.A., Gledhill S.R., Thomas R.D., Said S.A., Snyder G.L., Tay V.S., Jamrozik K. Preliminary results of the australasian regional anaesthesia collaboration: A prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications. Reg. Anesth. Pain Med. 2009;34:534–541
3. Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade. Brull R, Hadzic A, Reina MA, Barrington MJ Reg Anesth Pain Med. 2015 Sep-Oct; 40(5):479-90.
4. Ehmedah A, Nedeljkovic P, Dacic S, et al. Vitamin B Complex Treatment Attenuates Local Inflammation after Peripheral Nerve Injury. Molecules. 2019;24(24):4615. Published 2019 Dec 17. doi:10.3390/molecules24244615
5. Evaluation of brachial plexus anesthesia for upper extremity surgery. Urban MK, Urquhart B
Reg Anesth. 1994 May-Jun; 19(3):175-82
6. Robards C, Hadzic A, Somasundaram L, Iwata T, Gadsden J, Xu D, Sala-Blanch X: Intraneural injection with low-current stimulation during popliteal sciatic nerve block. Anesth. Analg 2009; 109:673–7
7. Liu SS, Zays VM, Gordon MA, et al. A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory shoulder surgery for postoperative neurological symptoms. Anesth Analg. 2009; 109(1): 265-271.


How to Cite this Article: Murty S, Murty K | Ropivacaine induced brachial plexus neurotoxicity- A case report | Journal of Anaesthesia and Critical Care Case Reports | September-December 2020; 6(3): —.

(Abstract) (Text HTML) (Download PDF)