Department of Anaesthesia, Rajagiri Hospital, Cochin, India

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Background and Aims This is a case report of a rare incident of possible LAST after a femoral nerve block in an 80-year-old female with intertrochanteric fracture of femur.

Methods The patient was on dual antiplatelets and CRF patient requiring dialysis 3 days a week. A rt femoral nerve block was planned with 20 ml 0.25% bupivacaine for pain relief. After scanning the inguinal region and identifying femoral nerve an 8 cm echogenic 22 G needle was directed near the femoral near after piercing the fascia, aspiration was done to see any blood .20 ml of 0.25% bupivacaine was injected in aliquots of 5 ml and aspiration was done after every 5 ml.

Results After 10 minutes patient started having abnormal involuntary movements and patient complained of perioral distaste and earache. The patient was hemodynamically stable but intermittent VPCs were noted in EKG. A clinical diagnosis of LAST was made and 1 mg of midazolam was given initially to control the involuntary movements. An initial bolus of 50 ml of 20% intralipid was given as a bolus intravenously in 10 minutes considering her age and comorbidities though the presentation was not mandating administration of intralipid. The involuntary movements decreased gradually and in 15 minutes patient became completely conscious and EKG became normal.

Conclusions A high degree of suspicion is required to anticipate LAST as it can present in different ways .20% intralipid has to made available in all areas where a regional anesthesia technique is used.