Local Anesthetic Systemic Toxicity after Combined Psoas Compartment–Sciatic Nerve Block

Vadi, Marissa G.; Patel, Neesa; Stiegler, Marjorie

doi:10.1097/aln.0000000000000154

Cited by 28 publications

(24 citation statements)

References 65 publications

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“…5,9,11,17,23,[32][33][34] The remaining cases resulted from neuraxial (13%: 4 of the 6 were epidural, 2 were described specifically as caudal injections), 16,20,26,29,30,38 paravertebral blocks (8.5%), 15,21,22,30 lower (8.5%) 6,7,13 and upper (8.5%) 6,31,36,39 extremity blocks, head and neck blocks (8.5%) (maxillary nerve, peribulbar), 14,19 topical, 28,35,37 transabdominis plane blocks, 8 and intravenous administration. 18 Seven cases (15%) involved continuous infusions of local anesthetic.…”

Section: Block Typesmentioning

confidence: 99%

“…Isolated CNS presenting features occurred in 45% (21/47), followed by combined CNS/CV toxicity 32% (15/47) and CValone 23% (11/47). Among the subgroup (15 of 47 cases) that had combined toxicity, CNS signs occurred first in 12 (75%) of the patients, 5,7,11,12,14,17,21,24,36,37,39 and CV signs occurred first in 3 (25%). 9,25,28 In 1 of these 3 cases, the patient was under general anesthesia when CV signs were noticed; therefore, the presence or absence of CNS toxicity is uncertain.…”

Section: Vascular Markersmentioning

confidence: 99%

“…Twenty-two patients (47%) were treated with ILE. 5,[7][8][9][10][11][12]14,15,17,21,23,24,26,29,30,32,34,37,39 In 1 case report, 39 ClinOleic 20% emulsion (Baxter, Deerfield, Illinois) was used instead of ILE. Nine patients received both a benzodiazepine and ILE.…”

Section: Treatment Of Lastmentioning

confidence: 99%

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Local Anesthetic Systemic Toxicity

Gitman

Barrington

2018

Regional Anesthesia and Pain Medicine

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This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single-center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade. Twenty-two patients (47%) were treated with ILE, and 2 patients (4.3%) died. During the same time period, 11 cases submitted to lipidrescue.org were treated with ILE and survived. The incidence of LAST reported in registries is 0.03% or 0.27 (95% confidence interval, 0.21-0.35) per 1000 peripheral nerve blocks (denominator of 251,325). Seizure (53% and 61% from case reports and registries, respectively) was the most common presenting feature.

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Section: Block Typesmentioning

confidence: 99%

Section: Vascular Markersmentioning

confidence: 99%

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Local Anesthetic Systemic Toxicity

Gitman

Barrington

2018

Regional Anesthesia and Pain Medicine

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“…For example, there are reports of fatal local anesthetic systemic toxicity and unnoticed accidental dural puncture. 8,22 Anesthesiologists should be aware of these major complications and have been advised to manage the psoas block with the same vigilance as a neuraxial procedure. 8 Moreover, anesthesiologists should be cognizant of arterial and venous anatomy within the lumbar nerve plexus and recognize that a psoas block can result in neuraxial anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Psoas Versus Femoral Blocks

Bomberg

Huth

Wagenpfeil

et al. 2017

Regional Anesthesia and Pain Medicine

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“…This has the potential to lead to an increased block failure rate and an increased incidence of complications, including local anesthetic toxicity as well as needle entry into the kidney or the epidural space. [3][4][5] The present study was designed to describe the surface landmarks used in the performance of the LP block in patients with spinal scoliosis. Additionally, we aimed to examine the correlation between the Cobb angle, an indicator of the severity of scoliosis, and the surface landmarks of the LP.…”

Section: Résumémentioning

confidence: 99%

Lumbar plexus block surface landmarks as assessed by computed axial tomography in adult patients with scoliosis: a case series

Robards

Riutort

Thomas

et al. 2015

Can J Anesth/J Can Anesth

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Background and objectives Lumbar plexus (LP) block is a common and useful regional anesthesia technique. Surface landmarks used to identify the LP in patients with healthy spines have been previously described, with the distance from the spinous process (SP) to the skin overlying the LP being approximately two-thirds the distance from the SP to the posterior superior iliac spine (PSIS) (SP-LP:SP-PSIS ratio). In scoliotic patients, rotation of the central neuraxis may make these surface landmarks unreliable, possibly leading to an increased block failure rate and an increased incidence of complications. The objective of the present study was to describe these surface landmarks of the LP in patients with scoliosis. Methods We selected 47 patients with known thoracolumbar scoliotic disease from our institution's radiology archives. We measured bony landmark geometry, Cobb angle, and the LP location and depth. Additionally, we calculated the SP-LP:SP-PSIS ratio for both the concave and convex sides. Results In scoliotic patients (31 females and 16 males), the median (range) Cobb angle was 23 (8-54) degrees. The LP depth was 7.5 (5.7-10.7) cm on the concave side of the scoliotic spine and 7.6 (5.4-10.8) cm on the convex side, while the distance from the SP-LP was 3.4 (1.9-4.7) cm on the concave side and 3.7 (2.4-5.1) cm on the convex side. The SP-LP:SP-PSIS ratio was 0.61 (0.20-0.97) and 0.65 (0.45-0.98) on the concave and convex sides, respectively. None of these distances were significantly different between sides. Conclusions In patients with scoliotic disease of the spine, there is wide variability in the bony surface landmarks. The location of the LP is generally more medial than expected when compared with both modified and traditional landmarks. A review of the imaging studies and the pre-procedural ultrasound assessment of the anatomy should be considered prior to needle puncture. RésuméContexte et objectifs Le bloc du plexus lombaire (PL) est une technique d'anesthésie régionale utile et souvent utilisée. Des repères cutanés servant à identifier le PL chez des patients ayant une colonne vertébrale normale ont été décrits antérieurement: la distance entre l'apophyse épineuse (AÉ ) et la peau recouvrant le PL étant approximativement les deux tiers de la distance séparant l'AÉ de l'épine iliaque postéro-supérieure (EIPS) (rapport AÉ -PL/AÉ -É IPS). Chez les patients scoliotiques, la rotation du névraxe peut rendre ces repères cutanés non fiables, menant possiblement à un plus grand taux d'échec

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Local Anesthetic Systemic Toxicity after Combined Psoas Compartment–Sciatic Nerve Block

Cited by 28 publications

References 65 publications

Local Anesthetic Systemic Toxicity

Local Anesthetic Systemic Toxicity

Psoas Versus Femoral Blocks

Lumbar plexus block surface landmarks as assessed by computed axial tomography in adult patients with scoliosis: a case series

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