A Case Report of a Bite From the Nile Crocodile (Crocodylus niloticus) Managed with Regional Anesthesia

Abstract

Crocodile attack injuries plague communities near bodies of water and continue to be an infrequent but significant form of trauma encountered in our medical facility. Regional anesthesia techniques are a novel adjunct to treatment and may facilitate simplified definitive management and better utilization of constrained operating room resources. We report a case of an adult male who presented with a large lower extremity wound after a crocodile bite. The patient was managed with initial debridement and irrigation and serial wound care entirely under regional anesthesia at the bedside. The patient did not develop wound infection, eventually receiving a skin graft with good functional outcomes. Regional anesthesia techniques are increasingly being used in the trauma setting, and their versatility allows for their use in multiple settings, by practitioners with limited experience and in resource-limited environments. No specific guidelines exist for performance of neuraxial techniques in the setting of animal bite injuries, but concerns about infectious complications have been raised. Regional anesthesia techniques may be useful in the management of extremity trauma due to crocodile attacks without infectious complications. They may reduce utilization of theatre resources and reduce opioid requirements.

Cranio-cervico-facial injuries due to crocodile bite: a rare observation in Yalgado Ouedraogo University Hospital (Burkina Faso)

“…The management of survivors of such attacks is medicalsurgical and includes general, local and rehabilitative care [2,4,[11][12][13]. At the general level, hydroelectrolytic resuscitation is necessary depending on the clinical presentation.…”

“…Crocodiles, semi-aquatic reptiles, remain the most dominant predators of lakes and rivers in the tropical world [1,2]. When they attack humans, their bites cause extensive mutilation and are fatal in more than one-third of cases [1].…”

“…In people who survive the attacks of this reptile, the lesions caused are serious because of their sepsis and the important tissue and blood losses that often follow them. Their management is therefore a medical-surgical emergency [2,3]. Crocodile attacks most often target the limbs or the trunk [1,2].…”

“…Their management is therefore a medical-surgical emergency [2,3]. Crocodile attacks most often target the limbs or the trunk [1,2]. Cephalic attacks have been very rarely described, particularly in sub-Saharan Africa [2,4].…”

“…Crocodile attacks most often target the limbs or the trunk [1,2]. Cephalic attacks have been very rarely described, particularly in sub-Saharan Africa [2,4]. Moreover, the few descriptions that have been made were mostly postmortem [5,6].…”