Multimodal analgesia in crotalid snakebite envenomation: A novel use of femoral nerve block

The American Journal of Emergency Medicine
David J BartonAnthony F Pizon

Abstract

Snakebite envenomations occur throughout the United States, with most envenomations resulting from Crotalid bites. These envenomations can result in severe pain despite aggressive analgesia due to effects of venom toxins. We report a case in which we treated a 44- year-old man who sustained a Copperhead (Agkistrodon contortrix) bite to his left hallux with progressive local toxicity, including severe pain radiating into his upper leg, without evidence of compartment syndrome or coagulopathy. His pain was unresponsive to multiple doses of opioids. We performed a fascia iliaca compartment femoral nerve block under dynamic ultrasound guidance with 20 mL of 0.25% bupivacaine, which provided substantial pain relief in his upper leg. To our knowledge, this is a novel application of regional anesthesia with peripheral nerve block. We demonstrate fascia iliaca compartment femoral nerve block may be a safe, beneficial technique for emergency physicians to utilize in providing multimodal analgesia in Crotalid envenomation.

References

Oct 1, 1996·Annals of Emergency Medicine·G T Garyfallou, J F Madden
Aug 6, 2010·The American Journal of Emergency Medicine·Andrew A HerringArun Nagdev
Dec 1, 2017·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·David D GumminWilliam Banner
May 8, 2018·Annals of Emergency Medicine·Casey Wilson

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Citations

Apr 6, 2019·Case Reports in Medicine·Murilo Sérgio Valente-AguiarRicardo Jorge Dinis-Oliveira

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