RLS > spinal

[minwoo]

---

Members don't see this ad.

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.

 

[drmwvr]

Why was she snoring? The spinal sure didn't "work".

 

[GassYous]

Just put a vial of sux in the leg after the tourniquet is up.

 

[BLADEMDA]

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.

 

[deleted162650]

Is RLS a local reflex arc mediated phenomenon??

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

 

[GassYous]

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]

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?

 

[Ronin786]

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

 

[Arch Guillotti]

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

I thought it was lateral tumors and the obturator nerve!

 

[deleted162650]

I thought it was lateral tumors and the obturator nerve!

You are correct sir.

 

[GassYous]

I thought it was lateral tumors and the obturator nerve!

Nice man

 

[repititionition]

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.

 

[Ronin786]

I thought it was lateral tumors and the obturator nerve!

You are correct. My bad.

 

[DrOwnage]

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.

 

[MirrorTodd]

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.

Interesting. I wasn't aware of that.

 

[minwoo]

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]

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.

 

[repititionition]

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.

this is fascinating. thank you for taking my knowledge to the next level.