Reactions 1138 - 10 Feb 2007

SBupivacaine

Respiratory insufficiency and hypotension followingepidural administration: case report

Before hysterectomy, a 50-year-old woman received highvolume epidural bupivacaine for expanding the epidural spacebefore catheter insertion, and developed respiratoryinsufficiency and hypotension.

During needle insertion at the L4-5 level, the dura wasinadvertently punctured. The needle was then placed at theL3-4 intravertebral space and, when a test dose of lidocaine3mL and epinephrine [adrenaline] did not elicit a reaction, thewoman received 0.5% bupivacaine 13mL and an epiduralcatheter was inserted. Sensory anaesthesia extending to the T4dermatome set in within 6–7 minutes and, within the next2 minutes, she developed hypotension and respiratoryinsufficiency.

The woman received mephentermine and IV fluids tomaintain her arterial BP. She then underwent generalanaesthesia, and was intubated and mechanically ventilated.Dopamine was infused to achieve haemodynamic stability.Surgery was uneventful. On awakening, she washaemodynamically stable and had a sensory level at T10.

Author comment: "We believe the rapid onset of sensory,motor, and sympathetic blockade resulted from bupivacaineentering the intrathecal space through the dural rent. Thedriving force . . . was the pressure resulting from injecting alarge volume of local anesthetic."Mahajan R, et al. A contraindication to using local anesthetic solution forexpanding the epidural space. Anesthesia and Analgesia 103: 1585-1586, No. 6,Dec 2006 - India 801026999

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Reactions 10 Feb 2007 No. 11380114-9954/10/1138-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved