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Is it safe to give an ankle block to a patient who is under fertility treatments?

Discussion in 'General Issues and Discussion Forum' started by vastview1972, May 17, 2016.

  1. vastview1972

    vastview1972 Member

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    Hi all,

    I have a patient booked for verruca needling treatment next Friday. She is currently having an IVF treatment and is having her IVF egg collection this week. So, technically, she could be pregnant by next Friday. I was wondering if it is safe to give her an ankle block. Could anyone help me with this? :confused:

    Thanks in advance!

    Last edited: May 17, 2016
  2. efuller

    efuller MVP

    Local anesthetics are used to give epidural anesthesia during birth. What does it say on the package insert? I would certainly go with that over what anyone says on an online forum.

    On the other hand, intentionally poking wart virus into the body is another question.
  3. Craig Payne

    Craig Payne Moderator

    I can't see it being a problem; but do as Eric suggested and check the LA insert.
  4. W J Liggins

    W J Liggins Well-Known Member

    Why would you wish to give an ankle block? I could understand a tibial block.

    Bill Liggins
  5. vastview1972

    vastview1972 Member

    Sorry, I did mean a tibial block.
  6. vastview1972

    vastview1972 Member

    Thanks for the replies.

    I postponed the needling initially as I thought the lady could technically be pregnant at the day she planned to have the procedure done and any local anesthetic could potentially be harmful to the foetus....

    Now, the lady confirms that the chance of pregnancy is excluded and I will go ahead with the treatment. I was informed that IVF egg collection is usually done under either GA or LA so it shouldn't be a problem to give a tibial block when patients are having fertility treatment. :)
  7. blinda

    blinda MVP

    What question would it raise, Eric?
  8. efuller

    efuller MVP

    The question of whether it is safe to try put a virus that causes abnormal growth of tissue into the blood stream of a women with a developing fetus. I have no idea whether this is a concern or not. On the one hand, pregnant women have probably had warts for eons and there haven't been any problems, that I'm aware of. On the other hand, if there is the zika virus. As I said, I have no idea if there is any research into the correlation of birth defects and human papiloma virus.

    I was just pointing out the irony that the lidocaine, which is used for epidural anesthesia during birth, may be less of a concern than the procedure.

  9. blinda

    blinda MVP

    I like your thinking, Eric. I was prompted to research similar questioning following a colleagues presentation on needling verrucae a few of years ago, when a member of the audience asked the speaker whether the consequences of introducing the Human Papilloma Virus to deeper tissues could be harmful.

    Whilst it is true that when a virus invades a host cell, it will cause a proliferation of that cell, we need to look at the viral genome make-up to ascertain its risk.

    The Zika virus is a member of the non-segmented, single-stranded, mosquito-borne flaviviruses, which is an RNA genome and has the potential to mutate during replication as such. It enters the bloodstream and invades their host cells; the white blood cell monocytes, which play a large part in our immune system, thus can have devastating effects on the CNS of both the directly infected and that of the unborn.

    Whereas, the Human Papilloma Virus (sub-types 1, 2 & 4 associated with the foot) is a double stranded DNA genome and cannot mutate as dictated by their DNA regulation of defects during replication in a host cell. It enters the epidermis through abrasions of the skin and does not go any deeper than the basal layer in the epidermis for self-preservation. If it were to, it would soon be eradicated by the immune regulators present in the dermis and deeper tissues. As it cannot mutate, survive or replicate in any other host cell other than the keratinocyte, it is thus classified as benign.

    With regards to research on introducing HPV deeper into the tissues, there is much research on auto-implantation of HPV to stimulate an appropriate cell-mediated response, which involves harvesting a wart, incubating the viral particles in a lab and then transplanting them back into the individual from which they were taken to initiate a controlled cell-mediated innate and adaptive immune response. The results are more than a tad interesting...

    Nice to have a different kinda discussion, eh?

  10. efuller

    efuller MVP

    Thanks Bel,

    It is always a pleasure to read a post that demonstrates a deep understanding of my question and then provides a well thought out, reasoned, and well explained answer.

    It was a pleasure meeting you in Spain.

  11. blinda

    blinda MVP

    Thanks, Eric.

    It was a great conference and good to meet you and your family, too.
  12. Lab Guy

    Lab Guy Well-Known Member

    Belinda is the Queen of Podiatric Dermatology!

  13. blinda

    blinda MVP


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