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Erschienen in:
06.06.2023 | Kasuistiken
Failure of local anesthesia
Technical shortcoming or true resistance?
Erschienen in: Die Anaesthesiologie | Ausgabe 10/2023
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A 55-year-old female patient presented in the anesthesia clinic prior to upcoming urgent percutaneous transluminal angioplasty (PTA) due to stenosis of the right common iliac artery caused by endometriosis. The intervention was planned with the patient under general anesthesia as the puncture for angiography performed 1 week previously had been painful despite local anesthesia with 2% lidocaine. The patient’s medical history was positive for numerous previous surgical interventions. In most of these instances, local anesthetics (LA) had had an inadequate effect, although several interventions could still be successfully performed (Table 1). Resistance to LA was also reported by the patient’s paternal aunt, albeit not by her father. The patient’s 19-year-old daughter is yet to undergo any surgical procedure. The patient additionally reported to have a generally reduced pain sensitivity and good cold tolerance; she can also tolerate holding hot objects without difficulty.
Table 1
Surgical interventions performed with the patient under local anesthesia (medical history taken in 2021)
|
Year
|
Intervention
|
Anesthesia
|
Effectiveness, “anamnestic”
|
|---|---|---|---|
|
2002
|
Secondary cesarean section
|
Spinal anesthesia
|
Difficult puncture, slight reduction of sensitivity in the legs, surgery performed with pain
|
|
2013
|
Carpal tunnel syndrome, left
|
Intravenous regional anesthesia
|
Good effectiveness
|
|
2013
|
Carpal tunnel syndrome, right
|
Intravenous regional anesthesia
|
Good effectiveness
|
|
2008
|
Infiltration, back
|
Local anesthesia
|
“Felt every prick”
|
|
Total of three dental treatments
|
Local anesthesia with 4% articaine, 1.7 ml
|
“High dosage and repeat administration required, ultimately pain-free after a long onset time, then numb for 1 day”
|
|
|
Total of three skin tumor excisions (thigh and back)
|
Local anesthesia
|
Interventions were painful
|
|
|
03/2021
|
Angiography
|
Local anesthesia
|
Inadequate effect
|