Workup and Management of Persistent Neuralgia following Nerve Block.

Paul David Weyker,Christopher Allen-John Webb,Thoha M Pham

doi:10.1155/2016/9863492

Paul David Weyker, Christopher Allen-John Webb + Show 1 more

Open Access

https://doi.org/10.1155/2016/9863492

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Abstract

Neurological injuries following peripheral nerve blocks are a relatively rare yet potentially devastating complication depending on the type of lesion, affected extremity, and duration of symptoms. Medical management continues to be the treatment modality of choice with multimodal nonopioid analgesics as the cornerstone of this therapy. We report the case of a 28-year-old man who developed a clinical common peroneal and lateral sural cutaneous neuropathy following an uncomplicated popliteal sciatic nerve block. Workup with electrodiagnostic studies and magnetic resonance neurography revealed injury to both the femoral and sciatic nerves. Diagnostic studies and potential mechanisms for nerve injury are discussed.

Highlights

Neurological injuries following peripheral nerve blocks are a relatively rare yet potentially devastating complication depending on the type of lesion, affected extremity, and duration of symptoms
We present the case of a patient who experienced chronic pain after perioperative femoral and sciatic nerve blocks
The reported incidence of complications following peripheral nerve blocks is not entirely known and changes depending on timing, definition of neurological injury, and anatomic location of the block

Summary

Introduction

Neurological injuries following peripheral nerve blocks are a relatively rare yet potentially devastating complication depending on the type of lesion, affected extremity, and duration of symptoms. Five types of nerve injury are described that range from neuropraxia (type 1), as evidenced by local myelin loss, to neurotmesis (type 5) demonstrated by complete disruption of the entire nerve and nerve sheath (Table 1) [1]. Given the nature of these injuries and the fact that many procedures are performed in ambulatory surgery centers, it is not uncommon for these complications to go undiagnosed until the first postoperative visit. To facilitate workup and management of these patients, many institutions have initiated a process through which these patients can be referred to a physician who specializes in either peripheral nerve injuries or pain management. The workup and management of peripheral nerve injuries secondary to peripheral nerve blocks will be discussed

Case Description

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Summary