Bupivacaine

Neurotoxicity after IV rexlon.' a~allesi. A. healthy l5-year-old W. Indian boy had an arm fracture reduced and immobilized using IV regional bupivacaine analgesia. No premedicants were given. An inflated tourniquet cuff was put on the arm. the arm was exsanguinated and l.5mg/kg 0.25 96 bupivacaine (total dose 9Smg) injected through an indwelling needle. 40 mins after injection the culT was released and within 4S sees the patient became unresponsive to commands, unaware of his surroundings and talked excitably about unrelated events. Limb twitching was not reduced by IOmg IV diazepam. but a further dose 12 mins later diminished the symptoms. However, the irrational talking continued. After sleeping soundly under sedation overnight, he had fully recovered neltt day. Presumably bupivacaine was released into the circulation after the cuff was deflated. Hend~r""l. A.M.: Briti"" Medical Journal 281, I043(Oct 18.1980)

0157-72.71/00/1114-0003/0$00.50/0 C ADIS Pre. RMctionaNuv 141980 3