Patient Experiences Prolonged Nerve Dysfunction After Ropivacaine Block in Case Report

A sixty-one-year-old female patient with a forty-year history of systemic lupus erythematosus and a twenty-year history of diabetes mellitus experienced prolonged neurological dysfunction temporally associated with regional nerve blocks administered for toe debridement surgery, according to a peer-reviewed clinical case report published in BMC Anesthesiology. The surgical procedure was performed using ultrasound-guided femoral and popliteal sciatic nerve blocks with an aggregate dose of 150 milligrams of 0.5 percent ropivacaine, corresponding to 2.7 milligrams per kilogram. Following the operative intervention, the patient developed severe sensorimotor impairment that persisted across a three-week clinical course.

The clinical case report establishes that peripheral neuropathy is a recognized complication associated with both diabetes mellitus and systemic lupus erythematosus. Medical researchers noted that these underlying chronic conditions can potentially increase neural vulnerability to local anesthetic agents, thereby lowering the threshold for adverse neurological events following nerve blockade.

To facilitate surgical toe debridement, clinicians administered ultrasound-guided regional nerve blocks targeting the patient’s lower extremity. Detailed clinical examinations documented complete sensory loss alongside grade 0 motor function below the knee, signifying an absolute absence of both superficial cutaneous sensation and voluntary muscular movement throughout the lower portion of the treated limb.

The patient’s sensorimotor deficit followed a protracted twenty-one-day clinical trajectory that differed substantially from conventional anesthetic recovery timelines. The patient experienced asynchronous sensory-motor recovery during rehabilitation. Furthermore, as neural function slowly began to return, she experienced pronounced pain hypersensitivity in the affected extremity. Extended neurological dysfunction markedly deviates from typical local anesthetic neurotoxicity recovery patterns.

On postoperative day twenty-one, clinicians performed comprehensive diagnostic electromyography to investigate the physiological extent and nature of the persistent neurological deficit. Electromyography on postoperative day 21 revealed chronic axonal polyneuropathy in both upper and lower extremities. In addition to these chronic generalized changes, the testing detected superimposed active denervation specifically localized within the left lower limb.

The authors emphasized that while the close temporal relationship strongly suggests possible anesthetic-related neurotoxicity superimposed on pre-existing neuropathy, several other potential contributing factors cannot be excluded from the clinical presentation. The differential diagnostic considerations outlined in the report include an acute-on-chronic worsening of diabetic neuropathy, systemic lupus erythematosus-associated chronic vasculitic neuropathy, and local ischemic nerve injury occurring during or after the surgical intervention. Because multiple pathological processes may have converged to produce the prolonged deficit, the case highlights the critical importance of conducting detailed preoperative neurological evaluations and formulating tailored anesthetic plans for patients who present with complex chronic conditions and suspected advanced peripheral neuropathy.

Subject of Research: Prolonged neurological dysfunction following ropivacaine nerve block in complex chronic neuropathy

Article Title: Prolonged neurological dysfunction after ropivacaine nerve block in a patient with systemic lupus erythematosus and diabetes mellitus: a case report

Article References: Wang, Y., Liu, Y., Huang, Y., & Yu, Y. (2026). Prolonged neurological dysfunction after ropivacaine nerve block in a patient with systemic lupus erythematosus and diabetes mellitus: a case report. BMC Anesthesiology. https://doi.org/10.1186/s12871-026-04358-x

Image Credits: AI Generated

DOI: 10.1186/s12871-026-04358-x

Keywords: ropivacaine, systemic lupus erythematosus, diabetes mellitus, peripheral neuropathy, femoral nerve block, popliteal sciatic nerve block, local anesthetic neurotoxicity, toe debridement, ultrasound guided nerve block, electromyography, axonal polyneuropathy, active denervation, sensorimotor deficit, pain hypersensitivity, vasculitic neuropathy, ischemic nerve injury, preoperative neurological evaluation