Post Your Cases > Mental status change after fascia iliaca

Fascia iliaca block performed with ultrasound guidance, single needle, continuous ultrasound visulization during the block. No sedatives given during the block-- no other sedative agents used preop.

60ml of .375% ropivicaine, 10 ml. of 2% lido injected over 2-3 min.

Mental status changes began 10 min. after block completed. Pt c/o of dizziness, slurred speech, moderately incoherent rambling. Intralipid 30% infusion started, with a 30 ml. bolus dose given. Improvement was not significant. Pt. was taken back to OR and GA induced-- at that point, at least 300 ml. of lipid infusion had gone in -- pt. still acting sedated and sluggish.

Postop in PACU, pt still appeared sedated. Painfree from block.
June 18, 2012 | Unregistered CommenterJL
Thank you for this interesting post. The patient's symptoms are very consistent with local anesthetic effect. However, I cannot speak to the clinical effect (or lack thereof) of 30% lipid emulsion since this has not been reported previously in the clinical literature. I would have predicted based on laboratory experience that sufficient volume of 30% would reverse the patient's obtundation. But one never knows.....We'll wait to hear if other people have similar experience. Meantime, I'd recommend using the standard 20% preparations as listed in every practice advisory.
Guy
June 19, 2012 | Registered Commenter[Guy Weinberg]