Can repeated scorpion bite lead to development of resistance to the effect of local anesthetics? Maybe it does!

Mridul M. Panditrao, Minnu M. Panditrao, V. Sunilkumar, Aditi M. Panditrao

Department of Anaesthesiology and Intensive Care, Padmashree Dr. Vithalrao Vikhe Patil Foundation’s Medical College & Hospital, Ahmednagar, India.
Department of Anaesthesiology and Intensive Care, Rand Memorial Hospital, Freeport, Bahamas, Commonwealth of the Bahamas;.

DOI: 10.4236/crcm.2013.22049                

Abstract

An 80 years old, bronchial asthmatic, male was posted for left cataract extraction with intra ocular lens implantation. He was administered peribulbar block/left facial nerve block. There was no sensory or motor block. Thereafter peribulbar block was repeated. Only partial akinesia was achieved, so under intermittent intra venous sedation, the surgery continued for 40 minutes. In the post-operative period, no signs of any residual/delayed block were noted. On specific enquiry, patient gave history of scorpion bite thrice, at the age of 27 years on his right foot, about 8-9 years back and again about 6-7 months back on his right hand. On 4th post-operative day after obtaining informed consent, local infiltration of the skin on the ventral aspect of the forearm, using, 6 mL, 2% lignocaine with adrenaline, was carried out. Confirming the suspicion, there was no sensory block after the injection, confirmed by pin prick method. Peribulbar block produces adequate intra-operative analgesia for cataract extraction. The cause of the failures may be due to technical inability to achieve block. However failure that occurs despite of technically correct injection of the correct drug can be mystifying. As the scorpion venom is known to affect the pumping mechanism of sodium channels in the nerve fibres, which are involved in the mechanism of action of local anaesthetic drugs, it may be responsible for the development of “resistance” to the action of local anaesthetic agents.

Keywords

Resistance to Local Anaesthetics; Multiple Scorpion Bites; Peribulbar Block; Ophthalmic Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Noyan, A.M.A., Mirghasemi, A.A. and Peiravy, S.H. (2007) True resistance to local anesthetics, a case report. Tehran University Medical Journal, 64, 97-100. http://journals.tums.ac.ir/abs/3253
[2]	Raw, R.M. and Nwaneri, E.R. (2010) Spinal anesthetic block failure due to the hyperbaric nature of the chloroprocaine local anesthetic. Ambulatory Surgery, 16, 99-102.
[3]	Binkley, C.J., Beacham, A., Neace, W., Gregg, R.G., Liem, E.B. and Sessler, D.I. (2009) Genetic variations associated with red hair color and fear of dental pain, anxiety regarding dental care and avoidance of dental care. JADA Continuing Education. Journal of the American Dental Association, 140, 896-905.
[4]	Liem, E.B., Joiner, T.V., Tsueda, K. and Sessler, D.I. (2005) Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads. Anesthesiology, 102, 509-514. doi:10.1097/00000542-200503000-00006
[5]	Liem, E.B., Lin, C.M., Suleman, M.I., Doufas, A.G., Gregg, R.G., Veauthier, J.M., et al. (2004) Anesthetic requirement is increased in redheads. Anesthesiology, 101, 279-283. doi:10.1097/00000542-200408000-00006
[6]	Panditrao, M.M., Panditrao, M.M., Khan, M.I. and Yadav, N. (2012) Does scorpion bite lead to development of resistance to the effect of local anaesthetics? Indian Journal of Anaesthesia, 56, 575-578. doi:10.4103/0019-5049.104582
[7]	Agasti, T.K. (2011) Ophthalmic anaesthesia. In: Agasti, T.K., Ed., Textbook of Anaesthesia for Post Graduates, JayPee, New Delhi, 1045.
[8]	Davis, D.B. and Mandel, M.R. (1994) Efficacy and complication rate of 16224 consecutive peribulbar blocks: A prospective multicenter study. Journal of Cataract & Refractive Surgery, 20, 327-337. doi:10.1016/S0886-3350(13)80586-X
[9]	Munhall, R.S., Sukhani, R. and Winnie, A.P. (1988) Incidence and etiology of failed spinal anesthetics in a university hospital. Anesthesia & Analgesia, 67, 843-848. doi:10.1213/00000539-198809000-00008
[10]	Kavlock, R. and Ting, P.H. (2004) Local anesthetic resistance in a pregnant patient with lumbosacral plexopathy. BMC Anesthesiology, 4, 1. doi:10.1186/1471-2253-4-1
[11]	Trescot, A.M. (2003) Local anaesthetic “resistance”. Pain Physician, 6, 291-293.
[12]	Ragsdale, D.S., McPhee, J.C., Scheuer, T. and Catterall, W.A. (1994) Molecular determinants of state-dependent block of Na+ channels by local anaesthetics. Science, 265, 1724-1728. doi:10.1126/science.8085162
[13]	Batas, D., Nejad, M.R.G. and Prabhu, P.K. (2011) Resistance to localanaesthetics: A case report. http://bja.oxfordjournals.org/cgi/qa-display/short/brjana_el;1576
[14]	Wee, C.K. (2011) Venoms [monographs on internet], 2011. http://web.singnet.com.sg/~chuaeecc/venom/venomcompo.htm
[15]	Adam, K.R. and Weiss, C.R. (1959) Actions of scorpion venom on skeletal muscle. British Journal of Pharmacology and Chemotherapy, 14, 334-339.
[16]	Karalliedde, L. (1995) Animal toxins. British Journal of Anaesthesia, 74, 319-32. doi:10.1093/bja/74.3.319
[17]	Zlotkin E (1981) Voltage dependent slowing of the turn off of Na+ current in the cockroach giant axon induced by the scorpion venom. Annual Review of Entomology, 27, 239-368.
[18]	Scholz, A. (2002) Mechanisms of (local) anaesthetics on voltage-gated sodium and other ion channels. British Journal of Anaesthesia, 89, 52-61. doi:10.1093/bja/aef163