Reactions 396 - 11 Apr 1992

Bupivacaine

Adverse effects following inadvertent extra-arachnoid injection: case report

A dramatic fall in BP to 50/0mm Hg occurred in a 31-year-old man 2 hours after initiation of combined epidural andgeneral anaesthesia for a graft to his right leg; epiduralanaesthesia comprised 0.5% bupivacaine 15ml Phenylephrinewas administered and the anaesthesia and surgery wereterminated.

The patient also developed delayed widespread sensory andsympathetic block after regaining consciousness; thiscombined with the development of profound hypotension andthe fact that negative aspiration and test-dose injection wereperformed following placement of the epidural catheterindicates that bupivacaine was inadvertently injected into thesubdural/extra-arachnoid space resulting in high sympatheticblockade. Placement of the epidural catheter in the subdural/extra-arachnoid space was confirmed radiographically. Thepatient recovered without sequelaeBoezaart AP, et al. Inadvertent extra-arachnoid (subdural) injection of a localanaesthetic agent during epidural anaesthesia. A case report. SAMJ South AfricanMedical Journal 81: 325-327, 21 Mar 1992 - South Africa 800128160

1

Reactions 11 Apr 1992 No. 3960114-9954/10/0396-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved