All Title Author
Keywords Abstract


Transient Femoral Nerve Palsy Complicating “Blind” Transversus Abdominis Plane Block

DOI: 10.1155/2013/874215

Full-Text   Cite this paper   Add to My Lib

Abstract:

We present two cases of patients who reported quadriceps femoris weakness and hypoesthesia over the anterior thigh after an inguinal hernia repair under transversus abdominis plane (TAP) block. Transient femoral nerve palsy is the result of local anesthetic incorrectly injected between transversus abdominis muscle and transversalis fascia and pooling around the femoral nerve. Although it is a minor and self-limiting complication, it requires overnight hospital stay and observation of the patients. Performing the block under ultrasound guidance and injecting the least volume of local anesthetic required are ways of minimizing its incidence. 1. Introduction Transient femoral nerve palsy (TFNP) occurs in 5–8% of ilioinguinal/iliohypogastric nerve (IIN/IHN) blocks [1, 2]. To the best of our knowledge it has been reported only once following a transversus abdominis plane (TAP) block [3]. We present our experience with 2 cases of TFNP complicating “blind” TAP blocks for inguinal herniorrhaphy, investigate its mechanism, and discuss possible ways of prevention. 2. Case 1 An otherwise healthy, 26-year-old, nonobese, male patient was scheduled to undergo right inguinal hernia plug-and-patch repair as a day case, under TAP block anesthesia and conscious sedation. Twenty mL of 0,5% ropivacaine were administered by an experienced anesthesiologist, using the landmark-based “two-pop” technique as described by McDonnell et al. [4]. Surgery was uneventful, with a duration of 45 minutes. At the postoperative ward round, the patient was disturbed and reported inability to extend the ipsilateral knee joint. Clinical examination revealed quadriceps femoris paresis, hypoesthesia over the anterior aspect of the thigh, and absent patellar reflex. The patient and his family were reassured, and the self-limiting nature of the complication was explained. He was admitted overnight for observation. On the following morning, symptoms had completely remitted, and he was discharged. 3. Case 2 A 62-year-old, nonobese, male patient, with an unremarkable past medical history, was scheduled to undergo left inguinal hernia plug-and-patch repair as a day case, under TAP block anesthesia and conscious sedation. Twenty mL of 0,5% ropivacaine were injected into the TAP by the same anesthesiologist. Surgery was uneventful, with a duration of 50 minutes. Two hours postoperatively he suffered from a minor orthopedic injury (ankle sprain) on his attempt to stand up from bed. On clinical examination he was found to have quadriceps femoris muscle weakness (grade 1/5 according to Louisiana State

References

[1]  K. R. Ghani, R. McMillan, and S. Paterson-Brown, “Transient femoral nerve palsy following ilio-inguinal nerve blockade for day case inguinal hernia repair,” Journal of the Royal College of Surgeons of Edinburgh, vol. 47, no. 4, pp. 626–629, 2002.
[2]  A. K. Lipp, J. Woodcock, B. Hensman, and K. Wilkinson, “Leg weakness is a complication of ilio-inguinal nerve block in children,” British Journal of Anaesthesia, vol. 92, no. 2, pp. 273–274, 2004.
[3]  G. Walker, “Transversus abdominis plane block: a note of caution!,” British Journal of Anaesthesia, vol. 104, no. 2, p. 265, 2010.
[4]  J. G. McDonnell, B. O'Donnell, G. Curley, A. Heffernan, C. Power, and J. G. Laffey, “The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial,” Anesthesia and Analgesia, vol. 104, no. 1, pp. 193–197, 2007.
[5]  Z. Jankovic, “Transversus abdominis plane block: the Holy Grail of anaesthesia for (lower) abdominal surgery,” Periodicum Biologorum, vol. 111, no. 2, pp. 203–208, 2009.
[6]  T. M. N. Tran, J. J. Ivanusic, P. Hebbard, and M. J. Barrington, “Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study,” British Journal of Anaesthesia, vol. 102, no. 1, pp. 123–127, 2009.
[7]  A. N. Rafi, “Abdominal field block: a new approach via the lumbar triangle,” Anaesthesia, vol. 56, no. 10, pp. 1024–1026, 2001.
[8]  P. Hebbard, Y. Fujiwara, Y. Shibata, and C. Royse, “Ultrasound-guided transversus abdominis plane (TAP) block,” Anaesthesia and Intensive Care, vol. 35, no. 4, pp. 616–617, 2007.
[9]  M. J. Young, A. W. Gorlin, V. E. Modest, and S. A. Quraishi, “Clinical implications of the transversus abdominis plane block in adults,” Anesthesiology Research and Practice, vol. 2012, Article ID 731645, 11 pages, 2012.
[10]  M. Farooq and M. Carey, “A case of liver trauma with a blunt regional anesthesia needle while performing transversus abdominis plane block,” Regional Anesthesia and Pain Medicine, vol. 33, no. 3, pp. 274–275, 2008.
[11]  P. Lancaster and M. Chadwick, “Liver trauma secondary to ultrasound-guided transversus abdominis plane block,” British Journal of Anaesthesia, vol. 104, no. 4, pp. 509–510, 2010.
[12]  D. J. Rosario, S. Jacob, J. Luntley, P. P. Skinner, and A. T. Raftery, “Mechanism of femoral nerve palsy complicating percutaneous ilioinguinal field block,” British Journal of Anaesthesia, vol. 78, no. 3, pp. 314–316, 1997.
[13]  D. J. Rosario, P. P. Skinner, and A. T. Raftery, “Transient femoral nerve palsy complicating preoperative ilioinguinal nerve blockade for inguinal herniorrhaphy,” British Journal of Surgery, vol. 81, no. 6, p. 897, 1994.
[14]  H. Kulacoglu, Z. Ergul, A. F. Esmer, T. Sen, T. Akkaya, and A. Elhan, “Percutaneous ilioinguinal-iliohypogastric nerve block or step-by-step local infiltration anesthesia for inguinal hernia repair: what cadaveric dissection says?” Journal of the Korean Surgical Society, vol. 81, no. 6, pp. 408–413, 2011.
[15]  G. McDermott, E. Korba, U. Mata et al., “Should we stop doing blind transversus abdominis plane blocks?” British Journal of Anaesthesia, vol. 108, no. 3, pp. 499–502, 2012.
[16]  J. Epperson and A. Reese, “Transient femoral nerve palsy following field block for inguinal herniorraphy,” The Internet Journal of Anesthesiology, vol. 11, no. 2, 2007.
[17]  H. Wulf, F. Worthmann, H. Behnke, and A. S. B?hle, “Pharmacokinetics and pharmacodynamics of ropivacaine 2 mg/ml, 5 mg/ml, or 7.5 mg/mL after ilioinguinal blockade for inguinal hernia repair in adults,” Anesthesia and Analgesia, vol. 89, no. 6, pp. 1471–1474, 1999.
[18]  F. W. Abdallah, V. W. Chan, and R. Brull, “Transversus abdominis plane block: a systematic review,” Regional Anesthesia and Pain Medicine, vol. 37, no. 2, pp. 193–209, 2012.
[19]  R. Taylor Jr., J. V. Pergolizzi, A. Sinclair, et al., “Transversus abdominis block: clinical uses, side effects, and future perspectives,” Pain Practice, vol. 13, no. 4, pp. 332–344, 2013.
[20]  M. Milone, M. N. D. Di Minno, and M. Musella, “Outpatient inguinal hernia repair under local anaesthesia: feasibility and efficacy of ultrasound-guided transversus abdominis plane block,” Hernia, 2012.
[21]  M. Weintraud, M. Lundblad, S. C. Kettner et al., “Ultrasound versus landmark-based technique for ilioinguinal-iliohypogastric nerve blockade in children: the implications on plasma levels of ropivacaine,” Anesthesia and Analgesia, vol. 108, no. 5, pp. 1488–1492, 2009.
[22]  N. Kato, Y. Fujiwara, M. Harato et al., “Serum concentration of lidocaine after transversus abdominis plane block,” Journal of Anesthesia, vol. 23, no. 2, pp. 298–300, 2009.
[23]  J. D. Griffiths, F. A. Barron, S. Grant, A. R. Bjorksten, P. Hebbard, and C. F. Royse, “Plasma ropivacaine concentrations after ultrasound-guided transversus abdominis plane block,” British Journal of Anaesthesia, vol. 105, no. 6, pp. 853–856, 2010.
[24]  Y. Shibata, Y. Sato, Y. Fujiwara, and T. Komatsu, “Transversus abdominis plane block,” Anesthesia and Analgesia, vol. 105, no. 3, p. 883, 2007.
[25]  Z. Jankovic, N. Ahmad, N. Ravishankar, and F. Archer, “Transversus abdominis plane block: how safe is it?” Anesthesia and Analgesia, vol. 107, no. 5, pp. 1758–1759, 2008.

Full-Text

comments powered by Disqus