Complete Sciatic Nerve Palsy following Pericapsular Infiltration during Total Knee Replacement—An Unusual Complication

Authors

  • Sanjay Bhalchandra Londhe Consulatant Orthopedic Surgeon, Criticare Superspeciality Hospital, Telli Galli, Andheri (East), Mumbai 400069, India
  • Meghana Patwardhan Anesthesia and Pain Medicine, Criticare Hospital, India
  • Ravi Shah Orthopedics Hinduja Healthcare, Khar, India
  • Mugdha Oak Anesthesia Criticare Hospital, India
  • Kavita Subhedar Clinical Research Criticare Hospital, India
  • Amit Doshi Engineering Meril Lifesciences, India
  • Shubhankar Londhe Computer Science, The Vishwanath Karad MIT World Peace University, Pune, Maharashtra, India

Keywords:

total knee replacement, sciatic nerve palsy, capsular infiltration, femoral nerve block

Abstract

Multimodal analgesia is the key to optimizing postoperative pain following total knee replacement surgery. In our institute, we follow a protocol of periarticular infiltration prior to implant, femoral/adductor canal single shot block immediate post-surgery combined with buprenorphine transdermal patch for the first 2 weeks for analgesia. In this particular patient, we observed that the patient had complete absence of power at ankle joint, as well as toe dorsiflexors and plantar flexors involving operated limb. Ankle reflex was absent. Also, there was complete analgesia and anesthesia in the L2 to L5 territory as compared with the contralateral limb that recovered completely by the end of 48 hours.

We have discussed three possibilities for the same: first, accidental injection around the sciatic nerve during periarticular infiltration; second, sciatic nerve block due to migration of drug following femoral nerve block; third, tourniquet-related nerve injury

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Published

2020-09-03

Issue

Vol. 4 No. 1 (2020): Journal of Peripheral Nerve Surgery

Section

Case Report