50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Introduction

Although silicone injections are illegal in the U.S., “black market” practitioners offer cosmesis through silicone injections (1)
There has been a recent surge of low-cost cosmetic treatments - 20% increase in buttock and lower body implants compared to pre-pandemic levels (2)
Many harmful effects of silicone injections have emerged: hyperpigmentation and fibrosis, epidermolysis, abscess and fistula formation, necrosis, and death due to pneumonitis, silicone embolus syndrome (SES), pulmonary edema, and sepsis (1)
No current reports in the literature examining silicone injections and regional anesthesia - we present a case of difficult peripheral nerve blocks and catheter placement in the setting of illicit silicone injections

Case Report

25 yo male with no PMH presented to the ED with 6% TBSA mixed thickness flame burns to his BLE
Hospital day 9: OR for RLE tangential excision & skin grafting - acute pain team consulted for pre-operative placement of continuous popliteal and adductor canal nerve catheters for perioperative pain control
Ultrasound exam complicated by diffuse areas of dropout and hypoechoic artifact interfering with visualization
Hospital day 16: return to OR for additional procedure -repeat popliteal catheter placement and single shot LFCN block performed; however, ultrasound imaging again obscured by areas of dropout
After repeated attempts at enhanced US visualization, patient informed block team of multiple illicit silicone injections in BLE for body and muscular contouring
Intra-op and post-op courses uncomplicated and perioperative pain well controlled with catheters and PNB

Discussion

Illicit cosmetic implants for body contouring are becoming increasingly popular in the U.S. (2)
Rates of cosmetic implants relatively high among patients identifying as transgender or gender non-conforming (3)
Little has been reported regarding regional anesthesia procedures and complications in patients with cosmetic implants - previous reports more focused on imaging and management of complications in patients with silicone and/or filler injections in facial region
We present the first case report addressing potential adjustments in regional anesthestic management of a patient with previously inserted cosmetic implants

LOWER EXTREMITY NERVE BLOCKS COMPLICATED BY COSMETIC SILICONE SOFT TISSUE INJECTIONS: A CASE REPORT