Injection-indeced sciatic nerve injury in Nigerian children

Abstract

Objectives: A retrospective study of all children with a diagnosis of sciatic nerve injury managed at the University College Hospital, Ibadan, Nigeria over a 12 year period was carried out in order to determine predisposing factors to the nerve injury and highlighting practical preventive measures. Design: The necessary data was collected from the case files of children seen at the hospital with a diagnosis of sciatic nerve injury, from 1988 to 1999. Results: There were 27 children aged five months to 12 years with a diagnosis of sciatic nerve injury. Twenty (74%) of the children were aged five years or less. While seven patients (26%) presented within two weeks of development of foot drop consequent on intramuscular (IM) injection given on the buttock, 20 patients (74%) presented much later. Fever was the most common complaint for which the injection had been given. The identity of the drugs given was not known in 10 patients. In the remaining 17 patients drugs administered were specified and included Chloroquine,Novalgin, Paraldehyde, Procaine penicillin, and Sulfadoxine-Pyrimethamine. Most of the patients had received the injections in privately owned medical facilities where staff with minimal training are often allowed to administer IM injections. Conclusion: It is suggested that the IM route for injection be strongly discouraged when a drug can be given by other routes. Only trained staff should be allowed to administer IM injections. Giving IM injections at sites other than the buttock maybe advantageous in children particularly those aged five years and below.

Post-injection Sciatic Neuropathy: A five-year review of cases managed in a paediatric hospital in Ibadan, Nigeria

“…Table 1 shows the age distribution pattern of the patients. Hamzat and Omotade (2006) and the 27 cases gathered over a period of 12 years by Fatunde and Familusi (2001). This shows the continued occurrence of PISN despite the current advances in medical practice.…”

“…An abscess in the vicinity can also cause PISN though with delayed presentation (M ansoor, 2004). Sciatic neuropathy is identified as a serious but preventable complication of gluteal intramuscular (IM ) injections (Fatunde and Familusi, 2001). Children are more vulnerable to PISN because of the variation in the thickness of their subcutaneous tissue and the depth of their gluteus musculature (Ahuja, 2003).…”

“…Sciatic neuropathy, especially in children, manifests by paresis in the distribution of the sciatic nerve, followed by minor to severe transient sensory disturbance -causalgia or burning pain in the extremity several hours or days later (M ayer and Romain, 2001). The diagnosis of sciatic palsy may be delayed for up to an average of 3.8 months after the gluteal IM injection (Fatunde and Familusi, 2001;Ahuja, 2003Ahuja, , M ansoor, 2004. Affected individuals usually present with foot drop and this can result in varying degrees of motor disability depending on the timing and duration of corrective measures instituted (Oyedeji et al, 2006).…”

“…The most reported causes of PISN are: unnecessary injections, and faulty techniques in the administration of injections by unqualified personnel (Fatunde and Familusi, 2001;Oyedeji et al, 2006). The W orld Health Organization (W HO) in 1999 reported that out of the 8-12 billion injections administered worldwide annually, the vast majority (90-95%) are for therapeutic purposes, 50 per cent are unsafe, and 75 per cent are unnecessary (M iller and Pisani, 1999;Halsey, 2003).…”

Injection-induced Sciatic Nerve Injury Among Children Managed in a Nigerian Physiotherapy Clinic: A Five-Year Review

“…The most common causes of injection nerve palsy are u n n e ce s s a r y in je c t io n s, fa u lty te ch n iq u e s a n d administration of injections by unqualified personnel (Adetunji et al, 2006;Fatunde and Familusi, 2001). Children with neurological conditions often require a rehabilitation team approach for optimum care (Logigian, 1989).…”