Reactions 1330 - 4 Dec 2010

SBupivacaine/epinephrine/ropivacaine

Seizures and cardiovascular collapse in anelderly patient, treated with soya oil emulsion:case report

An 83-year-old woman developed seizures andcardiovascular collapse after receiving bupivacaine/epinephrine and ropivacaine. She was successfully treatedwith soya oil emulsion.

The woman, who had a history of severe osteoarthritis,was admitted for a total knee arthroplasty. Prior to thesurgery, she received femoral and sciatic nerve blocksunder sedation. She was sedated with fentanyl andmidazolam and then received the femoral, followed by thesciatic nerve block. For each nerve block, 15mL of 0.5%bupivacaine with 1:200 000 epinephrine [adrenaline] and15mL of 1% ropivacaine was slowly injected through athreaded 20-gauge insulated catheter. About 5 to10 minutes after the sciatic nerve block, she developedbradycardia (30–40/min) and decreased BP (60–70mm Hgsystolic pressure). ECG revealed first degree heart block,progressing to complete heart block with multifocalventricular beats.

The woman received atropine and developed widecomplex ventricular tachycardia. She was unresponsive toverbal commands and started to have seizures. Midazolamwas administered immediately and she was intubated andventilated. Standard cardiac resuscitation was commenced.About 5 minutes later, she received two infusions of IV 20%soya oil emulsion [Liposyn]; each 250mL infusion wasadministered rapidly over 30 minutes. About 4 to 5 minutesafter the infusion, ECG showed wide complexintraventricular tachycardia, then normal sinus rhythm. BPand HR returned to baseline values and oxygen saturationwas 98% to 100% on mask ventilation and intubation. Shewas mechanically ventilated and sedated over the next4 hours in ICU, where her vital signs remained stable. Shewas extubated after a few hours in ICU and discharged thefollowing day.Varela H, et al. Use of lipid emulsions for treatment of local anesthetic toxicity: Acase report. AANA Journal 78: 359-364, No. 5, Oct 2010 - USA 803044739

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Reactions 4 Dec 2010 No. 13300114-9954/10/1330-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved