Delayed quadriceps weakness after continuous adductor canal block for total knee arthroplasty: A case report

Christopher Veal, David B. Auyong, Neil A. Hanson, Cindy J. Allen, Wyndam Strodtbeck

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Adductor canal catheters have been shown to improve analgesia while maintaining quadriceps strength after total knee arthroplasty. We describe a patient who underwent total knee arthroplasty that likely had delayed quadriceps weakness as a result of a standard continuous 0.2% ropivacaine infusion at 8 ml/h within the adductor canal. On the day of surgery, the patient was able to stand and ambulate with minimal assistance. On the first post-operative day after surgery, approximately 20 h after starting the ropivacaine infusion, profound weakness of the quadriceps was noted with no ability to stand. Contrast subsequently injected through the adductor canal catheter under fluoroscopy revealed proximal spread approaching the common femoral nerve with as little as 2 ml of volume. This rare case of profound quadriceps weakness after a continuous adductor canal block reveals that local anaesthetic at the adductor canal can spread in a retrograde fashion towards the common femoral nerve, potentially resulting in quadriceps weakness.

Original languageEnglish (US)
Pages (from-to)362-364
Number of pages3
JournalActa Anaesthesiologica Scandinavica
Volume58
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

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