Resistance to Local Anesthetics in Patients with a History of Scorpion Stings: A Systematic Review
-
Alireza Sharifian Attar
,
Pouria Namaee
,
Shima Sheybani
,
Masoumeh Tabari
,
Mahmoudreza Moharreri
,
Ali Moradi
Abstract
Background: Scorpion stings have been reported to induce inadequate block or block failure in local anesthesia. The present study has reviewed the resistance to local anesthetics in patients with a history of scorpion stings.
Methods: Articles from domestic and foreign journals in databases such as SID, IranMedex, Magiran, Uptodate, Google Scholar, Cochrane, Scopus, and Web of Science from 2010-2024 were searched, and ultimately 13 related high-quality articles based on STROBE were included in this review.
Results: According to the results of the included studies, which have dealt with scorpion sting cases and resistance to local anesthetics, patients with a history of scorpion stings experience significantly prolonged times of onsets for both sensory and motor blocks and the peak of sensory and motor blocks. Some of these patients have failed/inadequate sensory and motor block.
Conclusion: According to the mentioned materials, the prevalence of resistance to local anesthetics is higher in patients with a history of scorpion stings.
[1] Daneshi S, Rezabeigi S, Razzaghi A, Zeinali M, Arefi S. The epidemiological analysis of scorpion stings in Kerman 2012-14. Pejouhandeh. 2016; 21(1):35-9.
[2] Ali Mohammadi Y, Rajabi A, Azarbakhsh H, Esmaeilzadeh F, Ghorbani M. An Epidemiological Study on Scorpion Stings in Khuzestan Province (Haft Gel region), 2011-2012. Sadra Medical Journal. 2014;3(1):13-20.
[3] Nazari M, Bahrami D, Davari B, Salehzadeh A. Epidemiological Survey of Scorpion Sting Cases and Identification of Scorpion Fauna in Hamadan City, Iran (2013). Avicenna J Clin Med. 2015; 22(3):255-62.
[4] Zarei F, Sasani M, Zeinali-Rafsanjani B, Saeedi-Moghadam M. Assessment of the effectiveness of local anesthesia before thyroid fine needle biopsy considering the size of the nodule. Tehran Univ Med J. 2022; 80(7):563-7.
[5] Cao C, Jasim S, Cherian A, Nassar A, Chindris AM, Rivas AM, et al. Patient Discomfort in Relation to Thyroid Nodule Fine-Needle Aspiration (FNA) Performed with or without Parenteral and/or Topical Anesthetic. Endocr Pract. 2020; 26(12):1497-504.
[6] Tabari M, Farazestanian M, Azimi H, Esmaeilpour M, Hasanzadeh Mofrad M. Local injection of anesthetic agent in surgical incision in post-operation pain control: a review article. Tehran Univ Med J. 2021; 79(9):657-64.
[7] Zokaee H, Mirzaei F, Baghery moghadam S. Hypersensitivity Reaction to Local Anesthetic in Dentistry: A Case Report. J Res Dent Sci. 2021; 18(1):85-90.
[8] Shojaei AR, Haas DA. Local anesthetic cartridges and latex allergy: a literature review. J Can Dent Assoc. 2002; 68(10):622-6.
[9] Eriksson LI, Fleisher LA. Miller's Anaesthesia. 9th ed. Elsevier; 2017.
[10] Kosam D, Nigam R, Murthy M, Debbarma M, Chatterjee S. Effect of previous scorpion sting on the efficacy of spinal anaesthesia–a case control study. Int J Med Res Rev. 2015; 3(8):826-31.
[11] Fettes PD, Jansson JR, Wildsmith JA. Failed spinal anaesthesia: mechanisms, management, and prevention. Br J Anaesth. 2009; 102(6):739-48.
[12] Clendenen N, Cannon AD, Porter S, Robards CB, Parker AS, Clendenen SR. Whole-exome sequencing of a family with local anesthetic resistance. Minerva Anestesiol. 2016; 82(10):1089-97.
[13] Panditrao M, Panditrao M, Panditrao A. Development of Resistance to the Effect of Local Anesthetic Agents Administered Via Various Routes Due to Single or Multiple, Previous Scorpion Bites: A Proposed Hypothesis and Reporting a Yet Unrecognized PhenomenonJ Anesth Crit Care Open Access. 2015; 3:1.
[14] Arendt-Nielsen L, Kaalund S, Bjerring P, Høgsaa B. Insufficient effect of local analgesics in Ehlers
Danlos type III patients (connective tissue disorder). Acta Anaesthesiol Scand. 1990; 34(5):358-61.
[15] Hashemian AM, Omraninava A, Kakhki AD, Sharifi MD, Ahmadi K, Masoumi B, et al. Effectiveness of local anesthesia with lidocaine in chronic opium abusers. J Emerg Trauma Shock. 2014; 7(4):301-4.
[16] Liem EB, Joiner TV, Tsueda K, Sessler DI. Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads. Anesthesiology. 2005; 102(3):509-14.
[17] Bosmans F, Tytgat J. Voltage-gated sodium channel modulation by scorpion alpha-toxins. Toxicon. 2007; 49(2):142-58.
[18] Panditrao MM, Panditrao MM, Khan MI, Yadav N. Does scorpion bite lead to development of resistance to the effect of local anaesthetics? Indian J Anaesth. 2012; 56(6):575-8.
[19] Panditrao MM, Panditrao MM, Sunilkumar V, Panditrao AM. Effect of previous scorpion bite(s) on the action of intrathecal bupivacaine: A case control study. Indian J Anaesth. 2013; 57(3):236-40.
[20] Mridul M. Panditrao MMP, V. Sunilkumar, Aditi M. Panditrao. Can repeated scorpion bite lead to development of resistance to the effect of local anesthetics? Maybe it does! Case Rep Clin Med. 2013; 2:179-82.
[21] Issin A. Local anaesthetic resistance in a young woman with history of scorpion bite. Indian J Anaesth. 2015; 59(10):693-4.
[22] Kumar BK, Reddy TS, Raghuveer N. Local Anesthesia Failure Cases with Scorpion Bite History in Third Molar Surgery-A Challenge. 2017, 2(2): 7-10.
[23] Gokulakrishnan G UP. Scorpion sting and spinal anaesthesia-a rare case report. Indian J Appl Res. 2019; 9(11):50-1.
[24] Varghese RJ, Dhulkhed V. B187 Successful outcome of spinal anaesthesia in a patient with a history of scorpion sting and failed spinal anaesthesia. Reg Anesth Pain Med. 2022; 47(Suppl 1):A174.
[25] Tripathi S, Badlani B, Jain AK, Meravi J. Effect of
previous scorpion bite on the efficacy of intrathecally administered levobupivacaine in subarachnoid block. Asian J Pharm Clin Res. 2023;16(2):18-21.
[26] Gautam A, Tandon M, Gupta V, Gautam S, Rai S, Malviya D. Prospective study evaluating the association between time since scorpion bite and spinal anaesthesia outcomes. J Clin Diagn Res. 2023;17(7):UC07-9.
[27] Rath A, Reena R. Scorpion bite and failed spinal anesthesia: is ropivacaine the answer? Minerva Anestesiol. 2023; 89(4):368-9.
[28] Dalal KS, Chellam S, Toal PV, Panse S. Scorpion Sting: A Reason for Failed Local Anesthetic Action. J Res Innov Anesth. 2023; 8(2):57-9.
[29] Guinard JP, Carpenter RL, Smith HS. A prospective evaluation of the failure rate of spinal anaesthesia for transurethral prostatic resection. Eur J Anaesthesiol. 1992; 9(1):7-13.
[30] 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; 118(3):291-302.
[31] Butterworth JFt, Strichartz GR. Molecular mechanisms of local anesthesia: a review. Anesthesiology. 1990; 72(4):711-34.
[32] Son SL, Wong K, Strichartz G. Antagonism by local anesthetics of sodium channel activators in the presence of scorpion toxins: two mechanisms for competitive inhibition. Cell Mol Neurobiol. 2004; 24(4):565-77.
[33] Raw R, Nwaneri E. Spinal anesthetic block failure due to the hyperbaric nature of 2% chloroprocaine local anesthetic. Ambul Surg. 2011; 16:99-102.
[34] Possani LD, Becerril B, Delepierre M, Tytgat J. Scorpion toxins specific for Na+-channels. Eur J Biochem. 1999; 264(2):287-300.
[35] Cheun JK, Kim AR. Intrathecal meperidine as the sole agent for cesarean section. J Korean Med Sci. 1989;4(3):135-8.
[2] Ali Mohammadi Y, Rajabi A, Azarbakhsh H, Esmaeilzadeh F, Ghorbani M. An Epidemiological Study on Scorpion Stings in Khuzestan Province (Haft Gel region), 2011-2012. Sadra Medical Journal. 2014;3(1):13-20.
[3] Nazari M, Bahrami D, Davari B, Salehzadeh A. Epidemiological Survey of Scorpion Sting Cases and Identification of Scorpion Fauna in Hamadan City, Iran (2013). Avicenna J Clin Med. 2015; 22(3):255-62.
[4] Zarei F, Sasani M, Zeinali-Rafsanjani B, Saeedi-Moghadam M. Assessment of the effectiveness of local anesthesia before thyroid fine needle biopsy considering the size of the nodule. Tehran Univ Med J. 2022; 80(7):563-7.
[5] Cao C, Jasim S, Cherian A, Nassar A, Chindris AM, Rivas AM, et al. Patient Discomfort in Relation to Thyroid Nodule Fine-Needle Aspiration (FNA) Performed with or without Parenteral and/or Topical Anesthetic. Endocr Pract. 2020; 26(12):1497-504.
[6] Tabari M, Farazestanian M, Azimi H, Esmaeilpour M, Hasanzadeh Mofrad M. Local injection of anesthetic agent in surgical incision in post-operation pain control: a review article. Tehran Univ Med J. 2021; 79(9):657-64.
[7] Zokaee H, Mirzaei F, Baghery moghadam S. Hypersensitivity Reaction to Local Anesthetic in Dentistry: A Case Report. J Res Dent Sci. 2021; 18(1):85-90.
[8] Shojaei AR, Haas DA. Local anesthetic cartridges and latex allergy: a literature review. J Can Dent Assoc. 2002; 68(10):622-6.
[9] Eriksson LI, Fleisher LA. Miller's Anaesthesia. 9th ed. Elsevier; 2017.
[10] Kosam D, Nigam R, Murthy M, Debbarma M, Chatterjee S. Effect of previous scorpion sting on the efficacy of spinal anaesthesia–a case control study. Int J Med Res Rev. 2015; 3(8):826-31.
[11] Fettes PD, Jansson JR, Wildsmith JA. Failed spinal anaesthesia: mechanisms, management, and prevention. Br J Anaesth. 2009; 102(6):739-48.
[12] Clendenen N, Cannon AD, Porter S, Robards CB, Parker AS, Clendenen SR. Whole-exome sequencing of a family with local anesthetic resistance. Minerva Anestesiol. 2016; 82(10):1089-97.
[13] Panditrao M, Panditrao M, Panditrao A. Development of Resistance to the Effect of Local Anesthetic Agents Administered Via Various Routes Due to Single or Multiple, Previous Scorpion Bites: A Proposed Hypothesis and Reporting a Yet Unrecognized PhenomenonJ Anesth Crit Care Open Access. 2015; 3:1.
[14] Arendt-Nielsen L, Kaalund S, Bjerring P, Høgsaa B. Insufficient effect of local analgesics in Ehlers
Danlos type III patients (connective tissue disorder). Acta Anaesthesiol Scand. 1990; 34(5):358-61.
[15] Hashemian AM, Omraninava A, Kakhki AD, Sharifi MD, Ahmadi K, Masoumi B, et al. Effectiveness of local anesthesia with lidocaine in chronic opium abusers. J Emerg Trauma Shock. 2014; 7(4):301-4.
[16] Liem EB, Joiner TV, Tsueda K, Sessler DI. Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads. Anesthesiology. 2005; 102(3):509-14.
[17] Bosmans F, Tytgat J. Voltage-gated sodium channel modulation by scorpion alpha-toxins. Toxicon. 2007; 49(2):142-58.
[18] Panditrao MM, Panditrao MM, Khan MI, Yadav N. Does scorpion bite lead to development of resistance to the effect of local anaesthetics? Indian J Anaesth. 2012; 56(6):575-8.
[19] Panditrao MM, Panditrao MM, Sunilkumar V, Panditrao AM. Effect of previous scorpion bite(s) on the action of intrathecal bupivacaine: A case control study. Indian J Anaesth. 2013; 57(3):236-40.
[20] Mridul M. Panditrao MMP, V. Sunilkumar, Aditi M. Panditrao. Can repeated scorpion bite lead to development of resistance to the effect of local anesthetics? Maybe it does! Case Rep Clin Med. 2013; 2:179-82.
[21] Issin A. Local anaesthetic resistance in a young woman with history of scorpion bite. Indian J Anaesth. 2015; 59(10):693-4.
[22] Kumar BK, Reddy TS, Raghuveer N. Local Anesthesia Failure Cases with Scorpion Bite History in Third Molar Surgery-A Challenge. 2017, 2(2): 7-10.
[23] Gokulakrishnan G UP. Scorpion sting and spinal anaesthesia-a rare case report. Indian J Appl Res. 2019; 9(11):50-1.
[24] Varghese RJ, Dhulkhed V. B187 Successful outcome of spinal anaesthesia in a patient with a history of scorpion sting and failed spinal anaesthesia. Reg Anesth Pain Med. 2022; 47(Suppl 1):A174.
[25] Tripathi S, Badlani B, Jain AK, Meravi J. Effect of
previous scorpion bite on the efficacy of intrathecally administered levobupivacaine in subarachnoid block. Asian J Pharm Clin Res. 2023;16(2):18-21.
[26] Gautam A, Tandon M, Gupta V, Gautam S, Rai S, Malviya D. Prospective study evaluating the association between time since scorpion bite and spinal anaesthesia outcomes. J Clin Diagn Res. 2023;17(7):UC07-9.
[27] Rath A, Reena R. Scorpion bite and failed spinal anesthesia: is ropivacaine the answer? Minerva Anestesiol. 2023; 89(4):368-9.
[28] Dalal KS, Chellam S, Toal PV, Panse S. Scorpion Sting: A Reason for Failed Local Anesthetic Action. J Res Innov Anesth. 2023; 8(2):57-9.
[29] Guinard JP, Carpenter RL, Smith HS. A prospective evaluation of the failure rate of spinal anaesthesia for transurethral prostatic resection. Eur J Anaesthesiol. 1992; 9(1):7-13.
[30] 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; 118(3):291-302.
[31] Butterworth JFt, Strichartz GR. Molecular mechanisms of local anesthesia: a review. Anesthesiology. 1990; 72(4):711-34.
[32] Son SL, Wong K, Strichartz G. Antagonism by local anesthetics of sodium channel activators in the presence of scorpion toxins: two mechanisms for competitive inhibition. Cell Mol Neurobiol. 2004; 24(4):565-77.
[33] Raw R, Nwaneri E. Spinal anesthetic block failure due to the hyperbaric nature of 2% chloroprocaine local anesthetic. Ambul Surg. 2011; 16:99-102.
[34] Possani LD, Becerril B, Delepierre M, Tytgat J. Scorpion toxins specific for Na+-channels. Eur J Biochem. 1999; 264(2):287-300.
[35] Cheun JK, Kim AR. Intrathecal meperidine as the sole agent for cesarean section. J Korean Med Sci. 1989;4(3):135-8.
| Files | ||
| Issue | Vol 11 No 4 (2025): Autumn |
|
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v11i4.19378 | |
| Keywords | ||
| Local anesthetic resistance Scorpion sting Failed block Inadequate block | ||
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How to Cite
1.
Sharifian Attar A, Namaee P, Sheybani S, Tabari M, Moharreri M, Moradi A. Resistance to Local Anesthetics in Patients with a History of Scorpion Stings: A Systematic Review. Arch Anesth & Crit Care. 2025;11(4):579-584.
