Spinal anaesthesia in a patient with reported scorpion venom induced local anaesthetic resistance for a case of wound debridement for early physiotherapy

Abstract

A 63-year-old male was referred to the emergency department with road traffic accident injury to right lower limb. Patient had history of hypertension, chronic alcoholism, smoking, and scorpion sting twice 20 years ago. He had history of failed peribulbar block earlier. He developed necrotizing fasciitis for which he required general surgical debridement. Initial attempt with spinal anaesthesia with 2.5 ml of 0.5% hyperbaric bupivacaine was ineffective and as was an epidural top up. The case was conducted with General anaesthesia with supraglottic airway device. Since this poor response to local anaesthetics was preceded by stings of scorpion, it was decided to try a different drug regimen for intrathecal anaesthesia. A mixture of intrathecal bupivacaine 0.5% (0.6 ml), and pethidine 50 mg (1 ml), followed by intrathecal dexmedetomidine 5 mcg (0.1 ml) was administered, with a total volume of 1.7 ml. This case highlights challenges in treating scorpion envenomation due to sodium channel alterations by combining drugs with different targets