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An Extra long Single Shot Popliteal Nerve Block
Eman Nada MD, PhD, Michael Lucente, MD,
University of Massachusetts Medical School,
Department of Anesthesiology and Perioperative Medicine
A 71-year-old male with an extensive past medical history including type 1 diabetes mellitus iabetes mellitus complicated by diabetic retinopathy, nephropathy, as well as peripheral neuropathy, peripheral vascular disease, CVA x 2 and critical limb ischemia. He had undergone a left sided femoral to dorsalis pedis bypass as well as left great toe transmetatarsal amputation one week prior to the incident. The patient also had a history of five previous vascular surgeries related to diabetic and ischemic complications, ranging from debridement to transtarsal amputation.
This time he presented for debridement of the left great toe. Anesthesia was in the form of left popliteal nerve block using 0.5% Ropivacaine, in addition to monitored anesthesia care with no complications. Twenty four hours after the procedure we were contacted for persistent block. The patient still had foot drop and loss of sensation on the sole of the foot with recovery of plantar flexion and sensation on the dorsum of the foot. A neurologist and physical therapist were consulted, and a short term watchful follow up was advised and nerve conduction studies were planned. The patient was followed up daily by the phone until he had spontaneous recovery on post operative day three before the electro conductive study was performed.