Reactions 638 - 15 Feb 1997

Bupivacaine

CNS disorders following intrapleural administration:case report

Central nervous system toxicity occurred in a 58-year-oldwoman receiving a continuous intrapleural infusion ofbupivacaine for post-thoracotomy pain relief.

Following surgery, the woman was given a 20ml bolus doseof intrapleural bupivacaine 0.5%. She received 2 further 20mlbolus doses approximately 3 and 6 hours later and was thenstarted on a continuous intrapleural infusion of bupivacaine0.25% at a rate of 10 ml/h.

22 hours after the initial dose of bupivacaine, the woman’schest tube was clamped. Four hours later, she began toexperience disorientation, agitation, tinnitus, dizziness andhand tremor. Her BP had increased from 140/90 to180/110mm Hg and her HR had increased from 80 to 120beats/min.

The bupivacaine infusion was discontinued and the womanwas given oxygen and IV midazolam. One hour later, her CNSsymptoms had completely resolved. Subsequent analysis of ablood sample taken before the discontinuation of bupivacainerevealed a bupivacaine concentration of 3.86 µg/ml; thepotential range for CNS toxicity is reported to be 2–4 µg/ml.

Author comment: CNS toxicity after bolus intrapleuralinjections of bupivacaine has previously been reported in theliterature. However, ‘there are no reported cases of CNS toxicityin patients receiving continuous intrapleural analgesia.’Kreitzer JM, et al. CNS toxicity in a patient receiving continuous intrapleuralbupivacaine. Journal of Clinical Anesthesia 8: 666-668, Dec 1996 -USA 800494801

1

Reactions 15 Feb 1997 No. 6380114-9954/10/0638-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved