Effect of previous scorpion sting on the efficacy of spinal anesthesia - A case control study

  • Dr Durga Kosam Assistant Professor, Department of Anesthesiology and Critical Care, Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, CG, India
  • Dr Rakesh Nigam Associate Professor, Department of Anesthesiology and Critical Care, Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, CG, India
  • Dr Madhumita Murthy Associate Professor, Department of Anesthesiology and Critical Care, Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, CG, India
  • Dr Miltan Debbarma Assistant Professor, Department of Anesthesiology and Critical Care, Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, CG, India
  • Dr Sudarshana Chatterjee Professor, Department of Anesthesiology and Critical Care, Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, CG, India
DOI: https://doi.org/10.17511/ijmrr.2015.i8.155
Keywords: Motor block, Scorpion sting, Sensory block, Sodium channel, Spinal anesthesia

Abstract

Background: Failure/delayed effect of spinal anesthesia were noted in several patients with past history of scorpion sting during routine practice. Scorpion venom is known to delay the activation of sodium neuronal channels. Local anesthetic agents also act through the sodium channels. Therefore this study was conducted to test the association of scorpion sting with failure/resistance to effect of spinal anesthesia.

Methods: 40 patients in the age range of 18‑80 years were divided into two equal groups. Group 1 with past history of one or multiple scorpion stings and group 2 with no such history. The anaesthetic management was identical i.e. subarachnoid block with 3.5 ml. 0.5% Bupivacaine heavy. The onset of sensory and motor block was noted. Peaks of sensory and motor blocks were also observed. Sensory block was assessed by pin prick method and motor block by Bromage scale. After waiting for 20 min, general anesthesia was administered if the block was inadequate.

Results: The time of onset of sensory and motor block as well as the time for the peak of sensory and motor blocks was significantly prolonged in scorpion sting group. 5 patients had failed sensory and motor block. All the patients in control group had adequate subarachnoid block.

Conclusion: There is a direct association between previous scorpion sting and development of resistance to the effect of spinal anesthesia.

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References

1. Bawaskar HS, Bawaskar PH. Indian red scorpion envenoming. Indian J Pediatr. 1998 May-Jun;65(3):383-91.

2. Bawaskar HS, Bawaskar PH. Cardiovascular manifestations of severe scorpion sting in India (review of 34 children).Ann Trop Paediatr. 1991;11(4):381-7. [PubMed]

3. Fettes PD, Jansson JR, Wildsmith JA. Failed spinal anaesthesia: mechanisms, management, and prevention. Br J Anaesth. 2009 Jun;102(6):739-48. doi: 10.1093/bja/aep096. Epub 2009 May 6. [PubMed]

4. Kavlock R, Ting PH. Local anesthetic resistance in a pregnant patient with lumbosacral plexopathy. BMC Anesthesiol. 2004 Jan 16;4(1):1. [PubMed]

5. Haynes SR, Lawler PG. An assessment of the consistency of ASA physical status classification allocation. Anaesthesia. 1995 Mar;50(3):195-9. [PubMed]

6. Graham AC, McClure JH. Quantitative assessment of motor block in labouring women receiving epidural analgesia. Anaesthesia. 2001 May;56(5):470-6. [PubMed]

7. Guinard JP, Carpenter RL, Smith HS. A prospective evaluation of the failure rate of spinal anaesthesia for transurethral prostatic resection. Eur J Anaesthesiol. 1992 Jan;9(1):7-13. [PubMed]

8. Raw RM, Nwaneri ER. Spinal anesthetic block failure due to the hyperbaric nature of the chloroprocaine local anesthetic.Ambul Surg 2010; 16:99- 102.

9. Singh UK, Layland FC, Prasad R, Singh S. Poisoning in children.4th ed. New Delhi: Jaypee brother’s medical publishers (P) Ltd; 2013.

10. Ragsdale DS, McPhee JC, Scheuer T, Catterall WA. Molecular determinants of state-dependent block of Na+ channels by local anesthetics.Science. 1994 Sep 16;265(5179):1724-8. [PubMed]

11. Cestèle S, Scheuer T, Mantegazza M, Rochat H, Catterall WA. Neutralization of gating charges in domain II of the sodium channel alpha subunit enhances voltage-sensor trapping by a beta-scorpion toxin. J Gen Physiol. 2001 Sep;118(3):291-302.

12. Bosmans F, Tytgat J. Voltage-gated sodium channel modulation by scorpion alpha-toxins. Toxicon. 2007 Feb;49(2):142-58. Epub 2006 Sep 28. [PubMed]

13. Batas D, Nejad MR, Prabhu PK. Resistance to local anaesthetics: A case report. Published; 26th January 2007. Available from:http://www.bja.oxfordjournals.org/cgi/qa‑display/short/brjana_el; 1576. [Last accessed 2015 Aug 20]. [PubMed]

14. Panditrao MM1 Panditrao MM, Khan MI, Yadav N. Does scorpion bite lead to development of resistance to the effect of local anaesthetics? Indian J Anaesth. 2012 Nov;56(6):575-8. doi: 10.4103/0019-5049.104582.
CITATION
DOI: 10.17511/ijmrr.2015.i8.155
Published: 2015-09-30
How to Cite
1.
Kosam D, Nigam R, Murthy M, Debbarma M, Chatterjee S. Effect of previous scorpion sting on the efficacy of spinal anesthesia - A case control study. Int J Med Res Rev [Internet]. 2015Sep.30 [cited 2024Dec.23];3(8):826-31. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/329
Issue
Vol 3 No 8 (2015): SEPTEMBER
Section
Original Article