Ropivacaine
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Peripheral nerve disorders after continuous femoral block in an elderly patient: case report Peripheral nerve disorders occurred in a 72-year-old man after continuous femoral block with ropivacaine. He was later found to have a preexisting subclinical peripheral nerve disorder. The man underwent left total knee arthroplasty with continuous femoral nerve block, sciatic nerve block and spinal anaesthesia. He received 30ml ropivacaine 0.5% injected slowly through the femoral catheter and 20ml ropivacaine 0.5% slowly injected for sciatic nerve block. Spinal anaesthesia was achieved with bupivacaine. After the uneventful 150-minute surgery, ropivacaine 0.2% was given continuously through the femoral nerve catheter at a rate of 10 mL/h for postoperative analgesia; this infusion was stopped 48 hours later and the femoral catheter was removed 6 hours later. At this time, persistent weakness of the left quadriceps was detected along with hyposensitivity in the medial aspect of the thigh, and an absent patellar tendon reflex. On postoperative day 4, electrophysiological investigations revealed denervation in the medial vastus muscle, with similar findings in the right limb, consistent with a pre-existing peripheral nerve disorder. Six weeks after surgery, repeat investigations revealed a partial lesion of the femoral nerve indicating worsening of his existing peripheral nerve disorder. The man was discharged on postoperative day 9 with persistent weakness of the left quadriceps muscle, hyposensitivity of the medial aspect of the thigh, and absent patellar tendon reflex. Complete sensorimotor recovery of the left quadriceps muscle was noted at follow-up 6 months later. Author comment: "[A]lthough 0.5% ropivacaine is usually not neurotoxic, the underlying neuropathy of our patient may have contributed to make the femoral nerve more susceptible to the potential neurotoxic effect of continuous local anesthetic infusion." Blumenthal S, et al. Preexisting subclinical neuropathy as a risk factor for nerve injury after continuous ropivacaine administration through a femoral nerve catheter. Anesthesiology 105: 1053-1056, No. 5, Nov 2006 801026844 Switzerland
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Reactions 2 Dec 2006 No. 1130
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