Quadriceps-Sparing Femoral Nerve Block (Adductor Canal Block) Ultrasound exam revealed the distal femoral nerve branches in the adductor canal, accompanied by the superficial femoral artery and vein and bounded by the sartorius, adductors longus and magnus, and vastus medialis muscles. Careful attention was paid to note any intervening nerve or vascular structure. Lidocaine was placed subcutaneously. The block needle was introduced and ultrasound was used to guide the needle to the femoral nerve. A perineural infiltration was performed using both continuous ultrasound and aspiration every 5 mL to minimize risk of intravascular or intraneural injection. The spread of local anesthetic was assessed by ultrasound during the block and the needle removed.
around a minute after nerve block patient was noted to be gasping, started having tonic clonic movements. Given Midazolam 2.5 mg and started Intralipid bolus 100 ml followed by infusion at 20 ml/ hr. Jerking movements resolved following Midazolam and Intralipid. Patient monitored as sh swas post ictal. Patient was mildly hypotensive treated with phenylephrine; likely due to spinal block effects that she had received prior to nerve block. Spontaneous breathing maintained throughout on nasal canula with nasal airway inserted.
Regained consciousness around 20 minutes after seizure. Was back to baseline within an hour. Interesting her spinal wore off quicker than expected; I wonder if this was due to the intralipid.
Ultrasound exam revealed the distal femoral nerve branches in the adductor canal, accompanied by the superficial femoral artery and vein and bounded by the sartorius, adductors longus and magnus, and vastus medialis muscles. Careful attention was paid to note any intervening nerve or vascular structure. Lidocaine was placed subcutaneously. The block needle was introduced and ultrasound was used to guide the needle to the femoral nerve. A perineural infiltration was performed using both continuous ultrasound and aspiration every 5 mL to minimize risk of intravascular or intraneural injection. The spread of local anesthetic was assessed by ultrasound during the block and the needle removed.
around a minute after nerve block patient was noted to be gasping, started having tonic clonic movements. Given Midazolam 2.5 mg and started Intralipid bolus 100 ml followed by infusion at 20 ml/ hr. Jerking movements resolved following Midazolam and Intralipid. Patient monitored as sh swas post ictal. Patient was mildly hypotensive treated with phenylephrine; likely due to spinal block effects that she had received prior to nerve block.
Spontaneous breathing maintained throughout on nasal canula with nasal airway inserted.
Regained consciousness around 20 minutes after seizure. Was back to baseline within an hour. Interesting her spinal wore off quicker than expected; I wonder if this was due to the intralipid.