Effect of previous scorpion bite on the action of local anaesthetic agents: A case report

Scorpion bites are a relatively common phenomenon in the Indian subcontinent, especially in the countryside. Past history of scorpion bite, as a relevant and significant factor, during pre-anesthetic evaluation is infrequently taken, when patient comes for unrelated medical/surgical conditions. We hereby report a case of failure of subarachnoid block in an adult male, posted for lower limb orthopedic surgery. A 45-year-old, ASA grade 1 male patient was posted for elective right tibial nailing. Single-shot subarachnoid block was planned for the procedure, which failed. Sub-arachnoid block was repeated and again, there were no signs of sensory or motor blockade. At this point, on specific enquiry, the patient gave history of scorpion bite twice; first, at the age of 32 years, and the second time, about 10 months back. Thereafter, it was decided to give standard balanced general anaesthesia for the procedure. The surgery lasted for 90 min and was uneventful. Postoperatively, neurological examination of the lower limbs revealed incomplete sensory block by pin prick method and grade I motor block on Bromage scale (just able to flex/move knees). Scorpion venom may be responsible for the development of resistance to the action of local anesthetic agents. This case report discusses the possible correlations between scorpion bite and the failure of sub-arachnoid block.