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Misplaced injection

01 November 2003

Mr D worked as an engineer and had suffered from back pain for some time. An MRI scan showed a prolapsed intervertebral disc and surgery was recommended. After his surgery, Mr D developed urinary retention and was seen by Dr F, an RMO at the private hospital where the operation was carried out.

Dr F inserted a urinary catheter, giving an intramuscular injection of gentamicin into the left thigh as prophylaxis against infection associated with its insertion. Shortly afterwards, Mr D experienced pain and paresthesia, affecting the skin of his left thigh in the L 2 3 and 4 dermatomes. This pain persisted throughout his hospital stay and severely hampered his postoperative mobility.

Mr M, the operating consultant orthopaedic surgeon, saw Mr D shortly after the incident. He saw a needle mark on the lateral edge of the femoral triangle. Mr M felt that the injection was the likely cause of Mr D’s symptoms, causing femoral nerve irritation. He investigated the placement of metalwork inserted during surgery to see if this could be causing the pain, and even removed a spinal screw, in case this might be causing the symptoms, but to no avail.

An ultrasound scan of the femoral triangle failed to show any structural cause for Mr D’s symptoms. A pain specialist saw Mr D and confirmed the diagnosis of femoral neuropathy by performing a diagnostic femoral nerve block.

A legal claim was started against Dr F.

Expert opinion

Expert neurological opinion was that, on the balance of probability, Mr D had suffered an irritant femoral neuropathy as a result of a misplaced antibiotic injection. Mr D required regular input from a pain-management clinic and even tried surgery to insert a spinal stimulator to lessen his symptoms, unsuccessfully. He was left with marked pain, parasthesiae and weakness in the left leg.

We accepted liability for the injury on our member’s behalf, but were unable to agree an appropriate amount of compensation with his legal representatives At trial, a substantial sum was awarded to compensate Mr D for his pain, suffering and limitations on his employability.

Learning points

In our experience, neuropathic injections due to misplaced intramuscular (IM) injections are a frequent cause of negligence claims.

An IM injection may seem a basic procedure, but you should be sure of your competence to carry it out.

Before any invasive procedure in a given area, consider the anatomical position of any nearby vulnerable structures, and avoid actions that might damage them.

Before giving any therapy, ask yourself if it is necessary and justified.
In this case it probably wasn’t, and Mr D’s problems could have been avoided by not giving the injection in the first place.