Prolonged Neural Block After Lower-Limb Nerve Blocks in a Patient with Inherited Antithrombin III Deficiency - Implications for Regional Anesthesia

Sep 28, 2026

Peripheral nerve blocks can be effective for perioperative analgesia, but their safety and pharmacology in inherited antithrombin III (ATIII) deficiency remain insufficiently defined due to the condition’s rarity. A 58-year-old man with inherited ATIII deficiency underwent single-shot femoral and sciatic nerve blocks during lower-limb surgery. Motor deficits persisted for 2 days and sensory deficits for 8 days, suggesting unexpectedly prolonged inhibition. The report discusses venous stasis, microcirculatory impairment, and altered coagulation as plausible mechanisms, emphasizing cautious regional anesthesia in coagulation disorders.

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Local and Regional Anesthesia Open Access Full Text Article C ASE REPORT Prolonged Neural Block After Lower-Limb Nerve Blocks in a Patient with Inherited Antithrombin III Deficiency: Implications for Regional Anesthesia Takeaki Aizawa, Nami Sugiura, Shinji Sugita Department of Anesthesiology, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki-shi, Kanagawa, Japan Correspondence: Shinji Sugita, Department of Anesthesiology, Nippon Medical School Musashi-Kosugi Hospital, 1-383 Kosugi-cho, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan, Tel +81-44-733-5181, Fax +81-44-711-8713, Email [sugitashinji@nms.ac.jp](sugitashinji@nms.ac.jp) Purpose: Peripheral nerve block safety and pharmacology for patients with inherited antithrombin III (ATIII) deficiency remains unclear because of the rarity of the disease. Here, we report a case of unexpectedly prolonged motor and sensory inhibition following single-shot femoral and sciatic nerve blocks in a patient with inherited ATIII deficiency. We hypothesized that venous stasis, microcirculatory impairment, elevated peripheral venous pressure, and increased local tissue pressure might have contributed to prolonged nerve dysfunction and peripheral nerve injury. Case Report: The patient was a 58-year-old man (170 cm, 69 kg) with inherited ATIII deficiency. He was scheduled for 1-hour surgical debridement of recurrent venous stasis ulcers with microcirculatory impairment on his lower left leg. Nerve blocks resulted in motor and sensory deficits in the lower leg that lasted 2 and 8 days, respectively. The prolonged duration of this nerve block might have been related to his inherited ATIII deficiency. This condition can contribute to thrombosis of vessels such as the inferior vena cava, potentially leading to venous microcirculatory impairment in the lower limbs and complex coagulopathy. Conclusion: While peripheral nerve blocks are widely used for their efficacy and safety, the risk-benefit profile of regional anesthesia may be atypical in patients with coagulation disorders. This case highlights the need for cautious nerve block administration in patients with inherited ATIII deficiency. Keywords: antithrombin III deficiency, peripheral nerve block, prolonged single-shot femoral and sciatic nerve blocks, case report Introduction Peripheral nerve blocks (PNBs) are widely used for perioperative analgesia because of their efficacy and safety.1–3 However, inpatients with coagulation disorders, the risk-benefit profile of regional anesthesia may require additional considerations. Antithrombin III (ATIII) deficiency is an inherited or acquired thrombophilia characterized by reduced activity or concentration of antithrombin, which inhibits blood coagulation by inactivating thrombin and other active coagulation factors.4 Patients with ATIII deficiency, particularly the inherited type, are in a prothrombotic state over a lengthy course of disease. This prolonged duration can cause microvascular thrombosis and impaired capillary perfusion, especially in the venous circulation. Previous reports have described perioperative management strategies for patients with inherited ATIII deficiency, including anticoagulantsand neuraxial anesthesia.5–7 However, the safety and pharmacology of PNBs for these patients have been less clear because of the rarity of the disease. Here, we present a case of transient but prolonged motor and sensory inhibition following a single-shot lower-limb nerve block in a patient with ATIII deficiency. These outcomes raise concerns regarding the importance of altered anesthetic responses in the setting of venous microcirculatory impairment. Received: 2 September 2025 Accepted: 22 December 2025 Published: 27 December 2025 Local and Regional Anesthesia 2025:18 151–156 151 © 2025 Aizawa et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at [https://www.dovepress.com/terms](http

FAQs

What was the main purpose of this case report?

To evaluate peripheral nerve block safety and pharmacologic effects in a patient with inherited ATIII deficiency, where such evidence is limited due to disease rarity.

How long did the nerve-block effects last in the reported patient?

Motor impairment lasted 2 days and sensory impairment lasted 8 days after single-shot femoral and sciatic nerve blocks.

What mechanisms were proposed to explain the prolonged neural block?

Venous stasis and microcirculatory impairment were hypothesized to contribute, along with elevated peripheral venous pressure and increased local tissue pressure leading to prolonged dysfunction and possible peripheral nerve injury.

What is the clinical implication for regional anesthesia in ATIII deficiency?

The risk-benefit profile may differ in patients with coagulation disorders, so nerve block administration should be approached with caution in inherited ATIII deficiency.

Sep 28, 2026

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