Marcaine

[markjrn]

I have a patient that has had two peripheral nerve blocks that failed. The technique was good, the equipment was good, the patient just didn't respond to Marcaine.

Now a different doc wants to do a lumbar sympathetic nerve block, of course using Marcaine. Since Marcaine wasn't effective with the peripheral, would it be otherwise?

Inquiring minds want to know.

[maturner]

Were the two previous blocks administered at the same time? i.e. Fem and sciatic

More details please.

[markjrn]

Were the two previous blocks administered at the same time? i.e. Fem and sciatic

More details please.

The first block was done around the beginning of the month and the second one at the end of the month, as an outpatient. A catheter was inserted into the back of the leg and attached to an on-q ball (?). This person is now an inpatient and they've decided to try the lumbar sympathetic nerve block. He's concerned that the Marcaine won't work again, and I really don't have any help for them.

If Marcaine doesn't work in one place, will it work in another?

Thanks for the help. :)

[maturner]

Did the blocks work at all or did they simply not last beyond the duration of the surgery?

Did both blocks have catheters? If so, I would say you had a catheter issue most likely from migration of the catheter away from proximity to the nerve.

All of the local anesthetics work the same way, lidocaine, marcaine, ropivicaine etc.. Therefore it is not the marcaine that was the problem.

Catheters in peripheral nerve blocks can be technically challenging to place.

[markjrn]

Did the blocks work at all or did they simply not last beyond the duration of the surgery?

Did both blocks have catheters? If so, I would say you had a catheter issue most likely from migration of the catheter away from proximity to the nerve.

All of the local anesthetics work the same way, lidocaine, marcaine, ropivicaine etc.. Therefore it is not the marcaine that was the problem.

Catheters in peripheral nerve blocks can be technically challenging to place.

Both blocks had catheters, and apparently the patient initially had numbness for a few hours with the first block but nothing after that. With the second block, he had numbness again for a few hours and then normal sensation returned. At that time, he was bolused with Lidocaine and nothing happened. So it would seem that the catheter must have been placed correctly since there was initial numbness, but the meds couldn't sustain it?

There's a group of us kind of curious about this. We can't figure out if it's the Marcaine or what. It's not our area. :)

Thanks for the response!

[maturner]

If the blocked worked initially then there was no problem with the block or the marcaine. The bolus placed through the catheter did not work; therefore, the catheter was the problem. If the initial marcaine was placed via the catheter and the block worked then the problem is that the catheter migrated away from the nerve and the subsequent lidocaine bolus never reached its intended site of action.

[markjrn]

If the blocked worked initially then there was no problem with the block or the marcaine. The bolus placed through the catheter did not work; therefore, the catheter was the problem. If the initial marcaine was placed via the catheter and the block worked then the problem is that the catheter migrated away from the nerve and the subsequent lidocaine bolus never reached its intended site of action.

That's logical - makes perfect sense. I couldn't understand why Marcaine would work and then not work. This patient opted not to have the lumbar block because he didn't trust that it would work.

Thanks for the response. :)

[deepz]

......... I couldn't understand why Marcaine would work and then not work. .......

Many old-timers have been heard to say:

There is no such thing as inadequate regional anesthesia. Those would be instances of inadequate sedation.

.