Expert: Ronald Levy, M.D. - 9/21/2007

Question
QUESTION: Before I was put to sleep for knee replacement surgery, the
anesthesiologist introduced a student that would be doing
my nerve block on my leg.  The student tried to do the
nerve block halfway up on my inner thigh - it never numbed
anything. She said there was no exact science - and I was
taken to the surgery room & put to sleep.  Upon waking in the recovery room, I was in total agony with the most excruciating nerve pain running from my inner thigh to the
inside of my knee and down my calf! The doctor would never
acknowledge any problem - even though we continually asked
what could be wrong.  After being dismissed in four days
I was home overnight - and had to be taken back to the hospital by ambulance because I couldn't stand the horrific nerve pain.  I still  can't put my leg over the side of the
bed or put my foot down, without feeling like my calf will
burst. I'm still trying to get a doctor to help me.  The
doctor at the emergency room said the nerve block was supposed to have been done in my groin - therefore when
the tourniquet was put in place - further nerve damage was
done (not only with possible 2 nerve trunks being affected).
Please advise me at what I am in the middle of here??

ANSWER: I'm sorry for your pain. I can't speak for what the "student" did other than I'm sure he was being observed and instructed by the anesthesiologist (who hopefully knew what he was doing). He was correct about nerve blocks in that, it is not an exact science and it is done blindly but it should not cause the pain you have. Do you recall feeling shooting pains down your leg when the block was being performed?

Clearly you need to be seen by an anesthesia pain physician or a neurologist ASAP to evaluate the cause of your pain. If it is not treated, it may get worse and develop into a chronic problem such as Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS).

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: Unfortunately, the anesthesiologist introduced himself &
the student & left the student alone and unobserved.  The
student returned 3 times to see if my foot or leg were numb. I did have extremely sharp, shooting pain when she
was searching for the nerve to inject. After it was apparent that there was a problem, and a different anesthesiologist visited my room & said he thought that two
nerve groups had been affected (including the saphenous).
Why did my doctor show concern about his placement of the
tourniquet, since at that time he did not realize the block
was in the wrong place?  Do you think this is a long-term
injury?  It has been 16 days since surgery, and I have taken my first steps (with much pain) today!  Thank you for your time and advice.

With respect,
David


Answer
My only guess is that he put the tourniquet over the injection site and if the nerve was already injured then the additional pressure would not be very helpfule. As for it being a long term injury, probably not, unless it develops into CRPS which is why you should be seen by a pain specialist to evaluate you for that possibility.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston