minwoo

10+ Year Member
Jul 14, 2009
82
15
Status
  1. Attending Physician
Did a total knee earlier today on a ASA 3 lady with restless leg syndrome, easy uneventful spinal. But patient is jerking her legs nearly the entirety of the case. She's snoring away the whole case and has zero pain post-op so the spinal obviously worked. How the hell is she moving her legs though? Anyone experience anything like this and if so any tricks? Surgeon was getting super annoyed and I was pretty close to converting to GETA and paralyzing.
 
About the Ads

BLADEMDA

10+ Year Member
Apr 22, 2007
19,636
5,711
Southeast
Status
  1. Attending Physician
IMHO, the utilization of tetracaine with dextrose results in a very strong motor block; much more so than Bup with dextrose. Isobaric Bup has even less motor block than Heavy Bup.

If the RLS is bothering the surgeon place an LMA and add Propofol vs Sevoflurane.
 

SaltyDog

West Coast Anesthesiology Ninja
10+ Year Member
Aug 10, 2007
5,109
10,839
The Bight
Status
  1. Attending Physician
Is RLS a local reflex arc mediated phenomenon??

Edit: I guess that would still involve the cord which should be blocked. Never mind.
 
Jul 5, 2020
646
1,281
Status
  1. Attending Physician
Is RLS a local reflex arc mediated phenomenon??

Edit: I guess that would still involve the cord which should be blocked. Never mind.

I think it shouldn't be an issue with a good spinal but if it's good enough for surgery I don't know why it wouldn't be good enough to block motor. I can't explain it.
 

minwoo

10+ Year Member
Jul 14, 2009
82
15
Status
  1. Attending Physician
IMHO, the utilization of tetracaine with dextrose results in a very strong motor block; much more so than Bup with dextrose. Isobaric Bup has even less motor block than Heavy Bup.

If the RLS is bothering the surgeon place an LMA and add Propofol vs Sevoflurane.
Most certainly will do that next time. I used heavy bupivacaine and just trying to make sense of it pharma/physiologically. I'm wondering if RLS has more to do with intrinsic spasms of the muscles themselves and blockade of nerves are rendered irrelevant?
 
  • Like
Reactions: 1 user

Ronin786

7+ Year Member
Mar 27, 2011
1,698
1,777
Status
  1. Attending Physician
Most certainly will do that next time. I used heavy bupivacaine and just trying to make sense of it pharma/physiologically. I'm wondering if RLS has more to do with intrinsic spasms of the muscles themselves and blockade of nerves are rendered irrelevant?
Periodic Limb Movements are frequently described with spinal cord injury patients. It's possible that there is some sort of neuromuscular pathology inherent to RLS.

It's the same reason that urologists don't like spinals for TURBTs involving lateral tumors and the risk of bladder injury related to stimulation of the obturator nerve.

EDIT: Thanks Arch
 
Last edited:
  • Like
Reactions: 1 user

repititionition

Sure!
7+ Year Member
Feb 29, 2012
648
560
Status
only semi-related, many of the the patients I've seen who can just not stop jerking under adequate anesthesia have ESRD and are on dialysis. all of these patients are iron deficient, and iron-deficiency has a very strong link with RLS.
 
  • Like
Reactions: 1 users

DrOwnage

7+ Year Member
Oct 12, 2011
254
288
Los Angeles
Status
  1. Resident [Any Field]
Just my 2 cents. I've had 2 people with what appeared to be RLS manifesting under general anesthesia also. About a month ago in the cath lab during a GETA for an ablation I had a patient who was still moving their legs at a MAC of 1.2-1.3. So an LMA might not cut it sometimes if that's the sole purpose of general.
 

minwoo

10+ Year Member
Jul 14, 2009
82
15
Status
  1. Attending Physician
Just my 2 cents. I've had 2 people with what appeared to be RLS manifesting under general anesthesia also. About a month ago in the cath lab during a GETA for an ablation I had a patient who was still moving their legs at a MAC of 1.2-1.3. So an LMA might not cut it sometimes if that's the sole purpose of general.
Wow so paralytic seems to be the only way
 

PainDrain

5+ Year Member
Aug 26, 2014
1,693
2,193
Status
  1. Attending Physician
Is RLS a local reflex arc mediated phenomenon??

Edit: I guess that would still involve the cord which should be blocked. Never mind.
True RLS is a dopaminergic mediated phenomenon. Typically it presents in anemic and dialysis patients because the iron molecule is a cofactor for the synthesis of dopamine.
 
  • Like
Reactions: 6 users

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.
About the Ads