Reactions 961 - 26 Jul 2003

★Bupivacaine/fentanyl

Transient deafness following epiduraladministration (first report with fentanyl): casereport

A 30-year-old obese primagravida experienced transientbilateral hearing loss after each dose of epidural bupivacaineand fentanyl for pain relief during labour.

The woman received a test dose of lidocaine with no effect,followed by a first top-up of 10mL of bupivacaine 0.25%. Afterreceiving her first dose, and after each subsequent top-up of15mL bupivacaine 0.1% and fentanyl 2 µg/mL, she complainedof bilateral hearing loss which lasted for 30–60 seconds andresolved spontaneously. Due to a lack of labour progressionafter 10 hours she underwent a caesarian section; anaesthesiawas achieved with two 10mL boluses of bupivacaine 0.5% andfentanyl 5 µg/mL, and transient deafness occurred after eachdose. Her postoperative recovery was uneventful and she wasdischarged after 4 days.

Author comment: "There was no suspicion of duralpuncture in this case. It is possible that pressure changes in theCSF [cerebrospinal fluid] associated with injection of anepidural bolus could have contributed to the hearing loss."Rajasekaran AK, et al. Transient hearing loss with labour epidural. Anaesthesia 58:613-614, Jun 2003 - England 800945072

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of deafness associated withfentanyl. The WHO Adverse Drug Reactions database containedten reports of deafness associated with fentanyl.

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Reactions 26 Jul 2003 No. 9610114-9954/10/0961-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved