Reactions 1425 - 27 Oct 2012

SBupivacaine

Grand mal seizure in an elderly patient: casereport

A 74-year-old woman experienced a grand mal seizurewhile receiving bupivacaine.

The woman received bupivacaine for postoperativeanalgesia, following an extended left hemihepatectomy totreat a metastatic hepatic deposit after a diagnosis ofadenocarcinoma. While in recovery, a 20mL infusion ofbupivacaine 0.125% was initiated at a rate of 15 mL/hour,via a transversus abdominis plane catheter. She was alsoreceiving morphine via a patient-controlled pump. Onpost-operative day 2, 48 hours after initiation ofbupivacaine, she reported abdominal pain and her catheterwas loaded with a further 10mL of bupivacaine 0.125%.Forty-five minutes later, she experienced a grand malseizure; she was intubated and received artificialventilation, and she was transferred to an ICU. She wasdiagnosed with local anaesthetic toxicity.

Bupivacaine was discontinued at the time of the seizure,and the woman received 20% soya oil emulsion.

Author comment: "[W]e describe local anaesthetic toxicityin the context of a continuous transversus abdominis planeinfusion and acute postoperative hepatic impairmentfollowing liver resection."Hartley RA, et al. Local anaesthetic toxicity with continuous local anaestheticinfusion following hepatic resection. European Journal of Anaesthesiology 29:455-456, No. 9, Sep 2012. Available from: URL: http://dx.doi.org/10.1097/EJA.0b013e3283542081 - United Kingdom 803079101

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Reactions 27 Oct 2012 No. 14250114-9954/10/1425-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved