A 75-year-old woman (62 kg) with a fractured right neck of femur has a landmark-guided fascia iliaca compartment block using 30 mL of 0.25% levobupivacaine.
Two distinct pops were felt during needle advancement. Aspiration was negative and injection met no resistance.
Forty-five minutes later she has severe pain over the anterior thigh and hip, and sensation is intact over the lateral thigh.
What is the MOST likely reason for block failure?
A
Needle tip stopped between fascia lata and the fascia iliaca
B
The obturator nerve is not reliably reached by this block
C
Insufficient volume for adequate proximal and lateral spread
D
Inadvertent intravascular injection into the femoral artery
E
Onset of levobupivacaine exceeds 60 minutes at this strength