Reactions 1321 - 2 Oct 2010

SBupivacaine

Meningitis following intrathecal administration:case report

A 34-year-old woman developed chemical meningitisfollowing the administration of intrathecal bupivacaine.

The woman underwent successful caesarian delivery atan obstetrics clinic under anaesthesia with intrathecal 0.5%bupivacaine (10 mg) and IM pentazocine injection. Twohours after delivery, she became chilly and experiencedabdominal pain and headache.

The woman received pentazocine, which improved herabdominal pain. She became drowsy two and a half hourslater, with a body temperature of 39.1°C and a severeheadache. She was admitted to hospital. Her Glasgowcoma scale score was E4V2M4 upon admission. Shedisplayed a stiff neck, positive Kernig’s sign and mildlyincreased deep tendon reflexes in her lower extremities.She had elevated lactate dehydrogenase and alkalinephosphatase levels, and an elevated WBC count. Anincrease in cell count and total protein level were detectedby cerebrospinal fluid (CSF) examination. Tests for aninfectious cause were negative and brain MRI results werenormal. Findings were consistent with drug-inducedchemical meningitis, probably due to bupivacaine. Shereceived flomoxef a half day post-caesarian delivery as awound infection preventative. Her fever and headacheimproved, and almost completely disappeared by day 3,with improvement of the CSF abnormality. She wasdischarged on day 10 with almost normal CSF findings. Herstatus did not change over the following 2 months.Tateno F, et al. Bupivacaine-induced chemical meningitis. Journal of Neurology257: 1327-1329, Aug 2010. Available from: URL: http://dx.doi.org/10.1007/s00415-010-5522-7 - Japan 803040029

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Reactions 2 Oct 2010 No. 13210114-9954/10/1321-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved