Cardiac Arrest During an Ultrasound-Guided Sciatic Nerve Block Combined With Nerve Stimulation

The ASRA Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia and Pain Medicine

“…However, data are conflicting with regard to subsequent reduction in the occurrence of LASTV one audit showed no reduction as a function of localization technique, 46 whereas another audit 47 noted fewer seizures in the ultrasound group. Case reports 49,50 describe seizures despite the use of ultrasound. The overall frequency of LAST after UGRA (95% CI, 0.42Y1.9/1,000) is remarkably similar to that previously reported using PNS guidance.…”

Local anesthetic systemic toxicity

“…104 It has also been used successfully in the treatment of toxicity due to ropivacaine, 105 levobupivacaine, 106 and mepivacaine, 107 when each was used as the sole agent and in the treatment of toxicity due to a combination of lidocaine and ropivacaine. 108 Interestingly, only one of the multitude of case reports to date describes the use of an ultrasound-guided technique, 109 and there is no indication in this report that extravascular spread of local anesthetic was observed.…”

Update/Review

“…48,49 We also know that an upper limit of 7 mg/kg of lidocaine with epinephrine hand surgery is very safe because Burk et al 46 showed that safe levels of lidocaine after 35 mg/kg were infused in liposuction. However, all local anesthetics can cause fatalities if given in large doses, and bupivacaine 50,51 and ropivacaine 52,53 are known to be more cardiotoxic than lidocaine, which has actually been used extensively as a rescue agent in cardiac arrest. Intralipid has been used for both bupivacaine 54 and lidocaine 55 rescue.…”