Bupivacaine First report of third-degree * atrioventricular block following spinal anaesthesia: case report

A 32-year-old man was admitted for treatment of an uncomplicated ventral hernia. After IV Ringer's solution 700ml, BP was 140/88mm Hg, HR 82 beats/min and respiration rate was 16/ min. IV fentanyl 100,ug and oxygen 6 L/min was administered via a nasal Icannula. The patient was placed in a left lateral decubitus position and a spinal block using 0.75% bupivacaine 15mg was administered at the L2-3 Interspace.

Two minutes later, the patient developed nausea and tingling in his hands, with loss of sensation to pinprick to C5-6 bilaterally. Within 15 seconds he lost consciousness and no carotid pulse was palpable. ECG showed P-waves at a rate of 6O/min with no associated QRS complexes and no ventricular escape beats. 100% oxygen was administered plus IV a tropine 1.2mg. Repetitive precordial chest thumping over the mid-sternum was given . QRS complexes were initiated and the patient regained consciousness. Chest thumping was stopped and ECG showed perSisting third degree A-V block with occasional supraventricular conduction . The patient lost consciousness again within 10 seconds. Chest thumping was resumed and the patient awakened . Bradycardia occurred , followed by regular sinus rhythm thought to be due to circulat ing atropine. The operation proceeded without further incident and he was discharged 24 hours later.

This IS the first report of a third degree A-V block due to spinal anaesthetic. Thus , ' . . . pacing by precordial chest thump appears to be a benign and effective initial means of resuscitation in witnessed bradycardia or asystolic arrest'. Ches ter WL Spinal anesthesia complete heart block . and the precordial chest thump an unusual complication and a unique resuscl lallon Anesthesiology 69 600·602. Oct 1988 ....

0157-7271 / 88/ 1022-0005/ 0$01 .00/ 0 © ADIS Press REACTIONS$ 22 Oct 1988 5