Likely Local Anaesthetic Toxicity Following Dorsal Penile Nerve Block in an Adult. Early detection and Treatment with Lipid

Rao Kadam V,A Kumar

doi:10.2174/2589645801812010069

Abstract

Local Anesthetic Systemic Toxicity (LAST) should be considered after Local Anesthetic (LA) injection when patients experience Central Nervous (CNS) or Cardiovascular (CV) systems signs or symptoms. While LAST is a potentially fatal complication affecting both the CNS and CV, it can present as isolated CV toxicity. We report LAST presenting as isolate CV toxicity following bilateral penile block which responded to Intravenous Lipid Emulsion (ILE).

Highlights

Local Anesthetic Systemic Toxicity (LAST) should be considered in any patient receiving a Local Anesthetic (LA) injection and experiencing (CNS) or Cardiovascular (CV) systems signs or symptoms
The most common anesthetic techniques associated with LAST during three study review periods, 1979 -2009, 2010-2014 and 2014-2016 were epidural blocks, interscalene blocks and penile blocks respectively [1 - 3].The penile blocks reported were in pediatric cases only [3], with none occurring in adults
We would like to report an adult likely atypical presentation of isolated cardiac arrhythmia following bilateral dorsal penile block which responded to Intravenous Lipid Emulsion (ILE)

Summary

INTRODUCTION

Local Anesthetic Systemic Toxicity (LAST) should be considered in any patient receiving a Local Anesthetic (LA) injection and experiencing (CNS) or Cardiovascular (CV) systems signs or symptoms. While LAST is a potentially fatal complication affecting the above systems, it can present as isolated CV toxicity. The time course of the deterioration of initial dysrhythmias to asystole or malignant arrhythmias is not known. This potential progression may be amenable to early treatment with supportive measures, Intravenous Lipid Emulsion (ILE). The most common anesthetic techniques associated with LAST during three study review periods, 1979 -2009, 2010-2014 and 2014-2016 were epidural blocks, interscalene blocks and penile blocks respectively [1 - 3].The penile blocks reported were in pediatric cases only [3], with none occurring in adults.

CASE PRESENTATION

DISCUSSIONS AND RESULTS

CONCLUSION