Anesthesiology/Anesthesia

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Question
Greetings,
I am a 50 year old female. On May 29, 2015, I had a total knee replacement. Upon awakening, I was asked to mo e my leg. Not only could I not move my leg, I also could not feel it. I was told that this was normal with a femoral nerve block. I was told that it takes some people a little longer than others. I was in the hospital for five days during which I was never able to lift or feel my leg. Upon discharge, strangers had to help me get in my vehicle. Upon arriving home, I had to sit with my straight braced leg sticking straight out while I dragged myself up 15 steps to my bedroom. I had been informed that complications such as mine were extremely rare. The anesthesiologist called me constantly during my first few weeks home. She even attended some of my follow up appointments. I had home health PT to no avail. The PT wanted me to go to the emergency room because she felt so strongly that me being stuck upstairs was a safety issue.
It is now going on 4 months and I have had 3 emg/NCS studies. I had the first one 1 month after my surgery. They show both femoral and sciatic nerve damage. My surgeon thinks that the medicine somehow affected more than the intended nerve.
Every staff member that I have spoken to keeps telling me how "rare" these injuries are. But, this does not aid me when I am propped up in my bed unable to do anything involving my leg and praying that a fire or other emergency does not happen.

Have you ever seen a case such as this and do you have any idea how something like this could have happened?

There was no change in any of my emg/NCS tests and the thought of any more surgery terrifies me.

Answer
I'm sorry to read about your predicament.
It is true that nerve damage from nerve blocks are uncommon.  In fact, it is more common I. The studies to find nerve damage after surgeon where no nerve block was performed.  A more common cause of nerve damage in orthopedic surgery (like knee replacement ) is from the tounaquet placed around the leg.  To reduce blood loss the surgeon will request a tourniquet be placed around the upper thigh and inflated to a pressure of 300 mmHg.  This provides a bloodless field for the surgeon to work making the procedure much easier.  However, not only is blood flow shut off the the surgical site but the entire leg below the tours quiet which leads to some mild tissue damage and in some cases nerve damage. The biggest predicted of causing nerve damage from a tourniquet is duration its in place (ie >2 hrs), and predisposing risk factors such as long standing diabetes in the patient.  

To decide which caused your problems tourniquet, nerve block or other it is difficult but you can look at hints.  For example, you suffered nerve damage to the femoral and sciatic nerve.  This points to the tournaquet being the cause since a femoral nerve block would not cause damage to the sciatic nerve at all.

I don't have access to the EMG results or the NCS results but they can provide information on how long the damage has been there to some degree and can also give some input or clues to how likely you are to gain full recovery.  Nerve damage does tend to improve and very few people end up with permanent damage but in some cases it can take a year or longer.

I truly wish you the best in your recovery process and my hope is that you will gain some if not all function back at some point.  I'm not aware of any particular regimen that can improve your chances of recovery.
Dr Russell

Anesthesiology

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Rex Russell

Expertise

Any question dealing with general anesthesia issues. With particular emphasis on regional anesthesia.

Experience

I am a board certified anesthesiologist, graduated from residency in 2004 from Johns Hopkins Hospital. I have since worked as an anesthesiologist first in the Air Force for three years and then most recently in Texas in Private Practice.

Organizations
Texas Medical Association Texas society of Anesthesiologists American Society of Anesthesiologists

Education/Credentials
BS, BYU MD, U of Texas, Galveston Intern-St. Joe's Hospital, Phx, AZ Internal Medicine Residency-Johns Hopkins Hospital, Baltimore, MD

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