Reactions 1386 - 28 Jan 2012

Bupivacaine

Supraventricular tachycardia, treated with soyaoil emulsion: case report

A 26-year-old man developed supraventriculartachycardia (SVT) during intracostal nerve block withbupivacaine for postoperative analgesia and facilitation oftracheal extubation. He was successfully treated with soyaoil emulsion [Intralipid].

The man underwent transthoracic fixation of a dorsalvertebra under general anaesthesia, and received 0.5%racemic bupivacaine 5mL toward the end of surgery. Soonafter his first bupivacaine injection, he developed SVT withpeak HR of 244–250/min and invasive arterial pressures of50–56/30–36mm Hg.

Further anaesthetic administration was ceased, and theman received 10% soya oil emulsion, infused over15 minutes through his right internal jugular vein. His sinusrhythm normalised after injection of soya oil emulsion150mL, his haemodynamic status normalised, and hesubsequently remained stable. He was voluntarilyventilated for a day, and no further sequelae emerged.

Author comment: "[C]linically it is beyond doubt thatbupivacaine was the cause of tachyarrhythmia."Goyal R, et al. Supraventricular tachycardia after an intercostal nerve block withbupivacaine treated with 10% intralipid. Journal of Anaesthesiology ClinicalPharmacology 27: 564-565, No. 4, Oct-Dec 2011. Available from: URL: http://dx.doi.org/10.4103/0970-9185.86612 - India 803066389

1

Reactions 28 Jan 2012 No. 13860114-9954/10/1386-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved