Prolonged Duration of Peripheral Nerve Blockade in a Pediatric Patient with Charcot Marie Tooth Disease: A Case Report

Figures & data

Figure 1 Ultrasound-guided popliteal nerve block. (A) Proximal popliteal nerve with “onion-bulb” appearance, with needle placement and local anesthetic deposition. (B) Distal spread of local anesthetic, post-bifurcation of popliteal nerve.

Abbreviations: LA: local anesthetic. PN: popliteal nerve.

Table 1 Nerve Injury Following Peripheral Nerve Block

Common Mechanisms of Injury	Recommended Management of Injury^Citation11,Citation14,Citation15
Traumatic: mechanical and injection injury such as nerve compression, stretch (positioning injury), needle trauma (laceration or complete transection)^Citation11,Citation12,Citation14	Physical Examination: focused examination of affected extremity with emphasis on motor function as well as attempt to localize nerve(s) involved; identification of neuropathic pain and/or paresthesias^Citation11,Citation14,Citation15
Ischemic: vascular injury which may lead to local or diffuse ischemia such as from direct vascular injury or from hemorrhage within a nerve sheath^Citation11,Citation12,Citation14	Mild Deficit: close observation and reassurance^Citation11,Citation14,Citation15
Chemical: direct injury from injection solution (local anesthetic ± additives) with intrafascicular injection having highest association with injury^Citation11,Citation12,Citation14	Severe Deficit: baseline electrophysiologic studies (nerve conduction studies and electromyography) and nerve imaging studies within a few days of injury for baseline and then serial studies as determined by severity and clinical course^Citation11,Citation14,Citation15

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