Reactions 1266 - 22 Aug 2009

SBupivacaine

Neurologic deficits following spinal anaesthesia:case report

A 48-year-old man developed permanent asymmetricneurological deficits following spinal anaesthesia withbupivacaine [Marcaina] for varicose vein surgery.

The man received a single dose of 3.0mL of 0.5%hyperbaric bupivacaine (5 mg/mL) and his surgery wasuneventful. In the postanaesthesia care unit, his left legrecovered, but his right leg recovered only partially [time toonset not clearly stated]. Neurologic examination revealedright lower limb motor deficits, normal plantar reflex,absence of right patellar and Achilles reflexes, andhypoaesthesia for all sensory modalities below the rightT10 level. Electromyography suggestedmultiradiculopathy; there were normal sensory actionpotentials and acute motor denervation in his right L4-5-S1(severe) and left L5-S1 (moderate) segments. His sensoryfunctions improved slightly over the next several weeks,but his motor and sensory deficits remained unchangedover 2 years of follow-up.

Author comment: "[I]n the absence of another reasonableexplanation, we attribute the injury in this patient tobupivacaine neurotoxicity."Lima JE, et al. Permanent asymmetric neurologic deficits after spinal anesthesiawith bupivacaine. Anesthesia and Analgesia 109: 686, No. 2, Aug 2009 -Brazil 801150093

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Reactions 22 Aug 2009 No. 12660114-9954/10/1266-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved