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Open Access Highly Accessed Case report

Local anesthetic resistance in a pregnant patient with lumbosacral plexopathy

Renae Kavlock and Paul H Ting*

Author Affiliations

Department of Anesthesiology, University of Virginia Health Center, Charlottesville, Virginia, USA

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BMC Anesthesiology 2004, 4:1  doi:10.1186/1471-2253-4-1

Published: 16 January 2004

Abstract

Background

We report a case of a patient with apparent resistance to local anesthetics. While similar cases of failure of regional anesthetics are often attributed to technical failure, the overall clinical presentation and history of this patient suggests a true resistance to local anesthetics.

Case Presentation

This patient presented for elective cesarean section and the decision for regional anesthesia was made. While attempting to place an epidural, the patient failed to achieve adequate skin analgesia despite multiple attempts at local infiltration. When a spinal was ultimately placed, sensory or motor blockade was not obtained despite no evidence of technical problems with technique. Further questioning revealed multiple prior episodes of local anesthetic failure in this patient.

Conclusions

While the failure rate of spinal anesthesia has been shown range from 4–13% and is often attributed to technical failure, elements of this particular case suggest a true resistance to local anesthetics.