Post Your Cases > Successful rescue with LAST after adductor canal block

Patient was a 66yo white male s/p L TKA 120 kg. Patient was getting a L adductor canal block in PACU ultrasound guided. Needle tip visualized. Negative aspiration with incremental dosing of Marcaine 0.5% with epi 3-5 cc at a time. Always negative aspiration between doses. No apparent symptoms noted during the block. Within 2 minutes after block completed, patient had LOC and seized with immediate cardiovascular collapse. Patient intubated and CPR started. IV intralipids started within 2 minutes. During CPR patient received 4 mg total of IV epi in incremental doses and was shocked for VF arrest multiple times. Within 15 minutes ROSC achieved, with mild hypotension. Low dose epi infusion continued. Within 30 minutes patient awake and alert, VSS, and extubated. Epi stopped. Transferred to ICU for overnight observation. Patient stable with complaints of chest pain from rib fractures from high quality CPR and knee pain from his surgery. Total dose of intralipid given during the event was 600 cc.
May 5, 2016 | Unregistered CommenterGreg Barnett MD