Reactions 507 - 25 Jun 1994

SBupivacaine

Muscular disorders: case reportFollowing interscalene injections of bupivacaine and

epinephrine [adrenaline] during the capsular release of her leftshoulder, a 40-year-old woman developed local myopathy.

During the procedure, the patient received 45ml ofbupivacaine (0.5%) with epinephrine 5 µg/ml. 15 hours later,she had normal sensation in her hand but experiencedshoulder pain; this pain was treated over the following 19hours with a further 153.5 ml of bupivacaine (total dose1140mg) and epinephrine, with marginal success.

Pain persisted in the woman’s neck and tenderness of herleft sternocleidomastoid muscle (SCM) was noted 3 dayspostoperatively. Treatment with transcutaneous electricalnerve stimulation, NSAIDs and tricyclic antidepressants wasunsuccessful.

An electromyograph (EMG) indicated myopathy of her leftSCM and this was confirmed with a biopsy performed 54 dayspostoperatively. The woman was given oral prednisone for 4weeks and her symptoms gradually resolved 3 monthspostoperatively.

Author comment: ‘Clinical presentation, time course,laboratory investigations, EMG evaluation, magnetic resonanceimaging, and histology support the diagnosis of local myopathydue to bupivacaine injection.’Hogan Q, et al. Local anesthetic myotoxicity: a case and review. Anesthesiology80: 942-947, Apr 1994 - USA 800267636

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Reactions 25 Jun 1994 No. 5070114-9954/10/0507-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved