Anaes Cases · Ultrasound-guided peripheral nerve blocks
Intraneural injection during a popliteal block
The hot intraneural injection crisis — the recognition (nerve swelling + pain), the immediate withdrawal of the needle, the neurology assessment, and the monitoring for the nerve injury.
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ANZCAFRCAABAEDAIC
Prompt
During a popliteal sciatic nerve block, the local anaesthetic is seen to expand the nerve on the ultrasound, and the patient (lightly sedated) reports a severe shooting pain down the leg. Manage.
Presentation
A popliteal sciatic nerve block is being performed under ultrasound guidance with the patient lightly sedated. As the local anaesthetic is injected, the ultrasound shows the nerve expanding and swelling — the hypoechoic fluid is seen inside the nerve epineurium rather than around it. The patient reports a severe, sharp, shooting pain down the leg.
References1ShowHide
- [4]Neal JM, et al. American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version. Regional Anesthesia and Pain Medicine, 2021.PMID 33148630