An 80 years old woman with ischaemic/valvular heart disease, chronic low back pain and chronic lymphedema presented to the operating room for a left humerus fracture requiring surgery and fixation. We performed an interscalene nerve block with electrical nerve stimulation (50 mm needle) and ultrasound imaging for nerve localization. After careful aspiration for the nonappearance of blood we injected 20 ml of 0,75% ropivacaine (150 mg) in 5 ml increments. Unfortunately we faced technical problems in correctly visualizing the local anaesthetic related to a short neck and a the presence of a rigid bendage. Few seconds after injection, the patient developed perioral mioclonia, nystagmus and loss of consciousness. We quickly administered intravenous midazolam 4 mg , propofol 50 mg and called for help. As the patient was still unconscious, she was intubated after the administration of propofol 100 mg and rocuronium 50 mg. As soon as available (few minutes after the event) we started to inject intralipid 10% (our hospital doesn’t have the recommended solution of 20%) 400 ml as bolus and then 500 ml as continuous infusion in 30 minutes, according to national anesthesia society guidelines. The patient didn’t present hemodynamic instability unless a heart rate slowing (after sedation) which reached 48 bpm. The surgery has been postponed and the patient was admitted in intensive care unit to further monitoring. After less than 3 hours, the patient was awake with no neurological deficit, rapidly weaned from mechanical ventilation and then extubated. No further complications were noticed.
We performed an interscalene nerve block with electrical nerve stimulation (50 mm needle) and ultrasound imaging for nerve localization. After careful aspiration for the nonappearance of blood we injected 20 ml of 0,75% ropivacaine (150 mg) in 5 ml increments. Unfortunately we faced technical problems in correctly visualizing the local anaesthetic related to a short neck and a the presence of a rigid bendage.
Few seconds after injection, the patient developed perioral mioclonia, nystagmus and loss of consciousness. We quickly administered intravenous midazolam 4 mg , propofol 50 mg and called for help. As the patient was still unconscious, she was intubated after the administration of propofol 100 mg and rocuronium 50 mg.
As soon as available (few minutes after the event) we started to inject intralipid 10% (our hospital doesn’t have the recommended solution of 20%) 400 ml as bolus and then 500 ml as continuous infusion in 30 minutes, according to national anesthesia society guidelines.
The patient didn’t present hemodynamic instability unless a heart rate slowing (after sedation) which reached 48 bpm. The surgery has been postponed and the patient was admitted in intensive care unit to further monitoring. After less than 3 hours, the patient was awake with no neurological deficit, rapidly weaned from mechanical ventilation and then extubated. No further complications were noticed.