Post Your Cases > LAST event following Distal Femoral Nerve Block at the Adductor Canal

A total of 3 mg Versed was administered IV prior to local anesthetic injection. The femoral artery was identified deep to the sartorius muscle just proximal to the mid thigh under continuous ultrasound guidance. A skin wheal was placed with 1% lidocaine. A 4 inch echogenic needle was placed at the site of skin wheal. The block needle was placed and was visualized under ultrasound. The needle was advanced toward the femoral artery in an in-plane technique. The needle tip was passed deep to the fascia of the sartorius muscle, just lateral to the artery. Local anesthetic (0.5% ropivacaine, 30ml) was injected after negative aspiration in 5ml increments. Local anesthetic was seen to spread around the artery. The needle was withdrawn after adequate placement of local anesthetic. The patient was awake, alert and responsive throughout local anesthetic administration. He denied ringing in his ears and metallic taste in his mouth after repeated questioning through the injections. He was also without complaint of pain or paresthesia. Injection time was 1132-1133. At 1135, patient became unresponsive. At 1136, patient started to have seizure activity, intralipid IV infusion was initiated (200ml was given over approximately 3-5 minutes and then infusion was slowed and another 150ml given). At 1138, 1 mg Versed given IV. Ventilation assisted with bag-mask throughout seizure activity. At 1142, patient easily arousable, but drowsy and confused. Patient hemodynamically stable throughout event with no signs of CV compromise. No ectopy on telemetry and BP remained stable. Orthopedic procedure cancelled. Patient transported to recovery area. Observed for 4 hours post-seizure, remained stable with no signs/symptoms of LAST. Discharged to home.