Reactions 1121 - 30 Sep 2006

Bupivacaine

Bowel haematoma in a child : case reportA 6-year-old girl developed a bowel haematoma during

treatment with bupivacaine for an iliohypogastric-ilioinguinalnerve block for postoperative analgesia.

The girl underwent an emergency appendectomy; undergeneral anaesthesia, she received 0.25% bupivacaine 9mL andepinephrine [adrenaline], using a short bevel needle. Theneedle was inserted using a two ‘pops’ technique, 1cm medialand caudal to the anterior superior iliac spine (ASIS),perpendicular to the skin through the subcutaneous fascia.After the first pop, a third of the solution was injected; after thesecond pop, the second third of the solution was injected; thelast third of the solution was administered subcutaneously in afan-shape, in the direction of the ASIS. The peritoneum wasopened and a subserosal small bowel haematoma (about 2cmin diameter) was observed in the terminal ileum wall [time toonset of reaction not clearly stated].

The girl received conservative management; her surgerywas completed uneventfully with a nasogastric tube inserted,in case of small bowel obstruction. On arrival in the recoveryroom, she had no pain, and required only a dose of morphineand a dose of paracetamol [acetaminophen] postoperatively.One day after surgery, her nasogastric tube was removed; onpostoperative day 2, she was discharged. At a 2-week follow-up, she was asymptomatic.

Author comment: "It seems that in our case, the first‘pop’ that was felt represented the needle going through theinternal and external oblique muscles simultaneously and thesecond ‘pop’ through the transversus abdominus muscle."Frigon C, et al. Bowel hematoma following an iliohypogastric-ilioinguinal nerveblock. Pediatric Anesthesia 16: 993-996, No. 9, Sep 2006 - Canada 801046439

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Reactions 30 Sep 2006 No. 11210114-9954/10/1121-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved