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Abstract
An 80 years old, bronchial asthmatic, male was posted for left cataract extraction with intra ocular lens implantation. He was administered peribulbar block/left facial nerve block. There was no sensory or motor block. Thereafter peribulbar block was repeated. Only partial akinesia was achieved, so under intermittent intra venous sedation, the surgery continued for 40 minutes. In the post-operative period, no signs of any residual/delayed block were noted. On specific enquiry, patient gave history of scorpion bite thrice, at the age of 27 years on his right foot, about 8-9 years back and again about 6-7 months back on his right hand. On 4th post-operative day after obtaining informed consent, local infiltration of the skin on the ventral aspect of the forearm, using, 6 mL, 2% lignocaine with adrenaline, was carried out. Confirming the suspicion, there was no sensory block after the injection, confirmed by pin prick method. Peribulbar block produces adequate intra-operative analgesia for cataract extraction. The cause of the failures may be due to technical inability to achieve block. However failure that occurs despite of technically correct injection of the correct drug can be mystifying. As the scorpion venom is known to affect the pumping mechanism of sodium channels in the nerve fibres, which are involved in the mechanism of action of local anaesthetic drugs, it may be responsible for the development of “resistance” to the action of local anaesthetic agents.
Highlights
The ophthalmic surgical procedures are routinely performed under optimum analgesia and operative conditions, using either peribulbar or retro bulbar block with or without facial nerve block
The causes of failures may be due to technical difficulty and inability to inject the correct drug in appropriate dosage in correct place, which is obvious at that moment and is understandable
Since local anesthetics work via the sodium channel, it is theoretically possible that mutations in this channel might lead to differing responses to these medications [10]
Summary
The ophthalmic surgical procedures are routinely performed under optimum analgesia and operative conditions, using either peribulbar or retro bulbar block with or without facial nerve block. Resistance or “failure to achieve” adequate block by local anaesthetic agents is an uncommon but a known phenomenon [1]. Panditrao et al / Case Reports in Clinical Medicine 2 (2013) 179-182 routes like sub-arachnoid block in the patients giving history of scorpion bite, especially when exposure has been more than once, which we have recently reported [6]. We are presenting another one of such cases
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