Alp ALPTEKİN, Taylan AKKAYA, Emine ARIK, Derya ÖZKAN, Haluk GÜMÜŞ, Mine AKIN

Obturator sinir bloğu sonrası gelişen grand-mal konvulziyon

Bu olgu sunumunda, obturator sinir bloğunu takiben gelişen konvulziyon bildirilmektedir. Altmışyedi yaşında erkek hastaya serebrovaskuler olay sonrası gelişen hemipleji ve buna bağlı alt ekstremite adduktor kas spazmı nedeniyle obturator sinir bloğu uygulandı. Blokajdan 60 sn kadar sonra hastada bilinç kaybı ve tonik klonik kasılmalar görüldü. Obturator sinirin inguinal bölgede obturator kanaldan çıkış bölgesi zengin bir damar pleksusu komşuluğundadır ve blokaj sırasında bu pleksus zedelenerek istenmeyen damar içi enjeksiyon görülebilir.

Anahtar Kelimeler:

Sinir bloğu, Yaşlı, Erkek, İnme, Nöbetler, Obturator sinir

A case of grand-mal convulsion after obturator nerve block (case report)

Obturator nerve blockade was performed in a 67-year-old male patient with lower extermity adductor muscle spasm secondary to hemiplegia following a cerebrovasculary event. The patient lost conscious and tonic-clonic seizures developed approximately 60 seconds after the injection. Obturator nerve is in close proximity to a wide vasculary plexus at the outlet of the obturatory canal in the inguinal region. This plexus may get injured during the blockade and an unintended intravasculary injection can be observed.

Keywords:

Nerve Block, Aged, Male, Stroke, Seizures, Obturator Nerve,

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1. Trainer N, Bowser BL, Dahm L. Obturator Nevre Block for Painful Hip in Adult Cerebral Palsy. Arch Phys Med Rehabil 1986; 67(11): 829-830.
2. Moore DC, Bridenbaugh LD, Thompson GE, Balfour RI, Horton WG. Bupivacaine: a review of 11,080 cases. Anesth Analg 1978; 57(1): 42-53.
3. Brown DL., Ransom DM, Hall JA. Regional Anesthesia and Local Anesthetic-Induced SystemicToxicity: Seizure Frequency and Accompanying Cardiovascular Changes. Anesth Analg 1995; 81(2): 321-8.
4. Korman B, Riley RH. Convulsions induced by ropivacaine during interscalene brachial plexus block. Anesth Analg 1997; 85(5): 1128-9. BUNU ÇIKARSAK OLUR MU
5. Sim IW, Webb T. Anatomy and anaesthesia of the lumbar somatic plexus. Anaesth Intensive Care 2004; 32(2): 178-87.
6. Kendir S, Akkaya T, Cömert A et all. The Location of the Obturator Nevre: A Three Dimensional Description of the Obturator Canal. Surg Radiol Anat 2008; 30(6): 495-501.
7. Ölmez G, Özyılmaz MA, Karaman H, Kaya Z. Ropivakain ile Brakial Pleksus Blokajı Sonrasında Gelişen Grand Mal Konvulziyon: Olgu Sunumu. Türkiye Klinikleri Anesteziyoloji Reanimasyon 2006; 4(1): 29-33.
8. Raj PP. Adjuvant techniques in regional anesteshia. New York. Churchill Livingstone; 1985. p. 196-208.
9. Knudsen K, Beckman SM, Blomberg S, Sjovall J, Edvardson N. Central nervous and cardiovasculer effects of iv. İnfusion ropivacaine, bupivacaine and plasebo in volunteers. Br J Anaesth 1997; 78(5): 507-14.
10. Viel E, Pelas P, Ripart J, Pélissier J, Eledjam JJ. Peripheral neuroliytic blocks and spasticity. Ann Fr Anesth Reanim 2005; 24(6): 667-72.
11. Marhofer P, Schrogendorfer K, Wallner T et all. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med 1998; 23(6): 584-8.
12. Tanaka K, Oda Y, Funao T et all. Dexmedetomidine decreases the convulsive potency of bupivacaine and levobupivacaine in rats: involvement of alpha2-adrenoceptor for controlling convulsions. Anesth Analg 2005; 100(3): 687-96.
13. Choquet O, Capdevila X, Bennourine K, Feugeas JL et all. A new inguinal approach for the obturator nerve block: anatomical and randomized clinical studies. Anesthesiology 2005; 103(6): 1238-45.
14. Wassef MR. Interadductor approach to obturator nerve blockade for spastic conditions of adductor thigh muscles. Reg Anesth 1993; 18(1): 13-7.
15. Kakinohana M, Taira Y, Saitoh T et all. Interadductor approach to obturator nerve block for transurethral resection procedure: comparison with traditional approach. J Anesth 2002; 16(2): 123-6.