Reactions 968 - 13 Sep 2003

Bupivacaine

Aseptic meningitis: case reportA 64-year-old woman developed aseptic meningitis while

receiving combined continuous spinal and epidural analgesia(CSA).

The woman had been receiving epidural anaesthesia withbupivicaine and morphine for severe pain due to aretroperitoneal recurrence of rectal cancer. After 7 months theepidural anaesthesia had become less effective and CSAcomprising bupivacaine 1 mg/mL with saline soloution wasstarted, infused at a rate of 0.3 ml/h.

After 12 days the woman began to experience nausea,headache and a stiff neck. She was febrile and showed nuchalrigidity, with a positive Kernig sign. Both the CSA and epiduralcatheters were withdrawn and the tips cultured, with negativeresults. Her CSF had a WBC count of 4560/mm3, a proteincontent of 700 mg/dL and a glucose content of 34 mg/dL.Blood and CSF cultures were both negative and there was noevidence of a viral agent in the CSF but she receivedantibacterials and glycerol. A second CSF sample 40 hourslater revealed a WBC count of 372/mm3, glucose 61 mg/dL andprotein 354 mg/dL; cultures were again negative. Fifty hourslater she was afebrile and asymptomatic.

Author comment: We suspect that the cause waspreservatives in the bupivacaine solution, although this isimpossible to prove or confirm.Kasai T, et al. Aseptic meningitis during combined continuous spinal and epiduralanalgesia. Acta Anaesthesiologica Scandinavica 47: 775-776, Jul 2003 -Japan 800947560

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Reactions 13 Sep 2003 No. 9680114-9954/10/0968-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved