75 year old female with no significant comorbidities and weighing 80Kg was subjected to Lumbar Plexus Block under dual-guidance with a total 25ml Ropivacaine 0.5% following positive motor response and negative aspiration. 3 minutes after injection, loss of consciousness, hypotension (MAP ~ 30) and Bradycardia (40 bpm from a baseline of 80bpm).
Despite the abnormal presentation (no seizure, no tachycardia or other arrythmias), we opted for lipid therapy besides support with PPV and a total of 10+10mg Ephedrine. After extubation, she presented with focal neurological deficits, and loss consciousness once again - which is why she was intubated once again. CT scan ruled out ischemic or haemorrhagic stroke.
6 hours after the event, she had recovered fully. She never presented visible seizures, and her HD instability wasn't typical of LAST. However, the time-proximity to the block made me wary of not treating what could be a possible trigger.
Differential diagnosis would include epidural / subdural / intrathecal spread, stroke, or fat embolism.
Despite the abnormal presentation (no seizure, no tachycardia or other arrythmias), we opted for lipid therapy besides support with PPV and a total of 10+10mg Ephedrine. After extubation, she presented with focal neurological deficits, and loss consciousness once again - which is why she was intubated once again. CT scan ruled out ischemic or haemorrhagic stroke.
6 hours after the event, she had recovered fully. She never presented visible seizures, and her HD instability wasn't typical of LAST. However, the time-proximity to the block made me wary of not treating what could be a possible trigger.
Differential diagnosis would include epidural / subdural / intrathecal spread, stroke, or fat embolism.