Ropivacaine Induced Brachial Plexus Neurotoxicity- A Case Report

Abstract

Background: Neurotoxicity of the nerves has been reported to be related to the concentration or volume of local anaesthetic used. We report a case wherein the volume and concentration of local anaesthetic used was well within the safe limits. Despite the safe precautions taken, the patient developed a profound motor and sensory block which took nearly 20 weeks to resolve. Case presentation: A 72-year-old female patient scheduled for a total shoulder arthroplasty received a single shot interscalene block under ultrasound guidance. A total volume of 10mls of ropivacaine 0.375% was injected under direct ultrasound guidance. The patient experienced no pain on injection and neither was there any paraesthesia on needle placement. We encountered no high pressures during the injection. The patient had a profound block which lasted for over 20 weeks. The patient was followed up at regular intervals which showed a slow recovery pattern. Conclusion: Local anaesthetics are known to cause neurotoxicity. This case highlights the need to be mindful about potential sequelae to nerve blocks despite using a lower concentration and volume of local anaesthetic. Key Words: Interscalene block; Neurotoxicity; Ropivacaine