Reactions 1323 - 16 Oct 2010

SBupivacaine

Paraesthesia and bradycardia in an elderlypatient: case report

A 78-year-old man with a forearm fracture developedsystemic toxicity following bupivacaine administration toachieve subcoracoid brachial plexus block.

The man received repeated 5mL injections of 0.25%bupivacaine (a total of 40mL). Thirty-two minutes after theend of the injection, he developed peribuccal paraesthesiasand accommodation difficulties, followed by muscletwitching, particularly involving his face. He subsequentlybecame agitated.

The man was administered oxygen via a face mask, andmidazolam. He subsequently developed bradycardia withlarge QRS complexes, which persisted despite atropineadministration, arterial hypotension and a drop in SpO2.Due to symptoms, a diagnosis of systemic toxicity ofbupivacaine was considered. An infusion of soya oilemulsion [Intralipides] was given and his bradycardiaresolved within 30 seconds. In less than 3 minutes, heregained consciousness and his BP, HR and SpO2 hadincreased. The scheduled surgery was performed due to hisrapid recovery from the adverse reaction.

Author comment: With respect to a possible explanationof systemic toxicity of bupivacaine, the kinetics of the onsetof toxicity signs suggest a phenomenon of absorption ratherthan an accidental intravascular injection.Zhurda T, et al. Usefulness of lipidic solution for the treatment of systemic toxicityrelated to bupivacaine injected in a sub-coracoid brachial plexus block. AnnalesFrancaises d’Anesthesie et de Reanimation 29: 592-593, Jul 2010. Available from:URL: http://dx.doi.org/10.1016/j.annfar.2010.05.019 [French; summarised fromtranslation] - Albania 803042073

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Reactions 16 Oct 2010 No. 13230114-9954/10/1323-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved