Reactions 1324 - 23 Oct 2010

Bupivacaine/fentanyl

Paralysis of intercostal muscles in a child: casereport

An 11-year-old girl developed unilateral paralysis of theintercostal muscles after receiving bupivacaine andfentanyl.

The girl received postoperative analgesia through anepidural catheter consisting of 0.25% bupivacaine 10mL asan initial bolus, followed by a continuous epidural infusionof 0.1% bupivacaine and 2 µm/mL of fentanyl. The catheterwas located at the T8–T9 level and the infusion rate variedbetween 3 and 12 mL/hour. She received the epiduralsubsequent to an anterior instrumented spinal fusioncorrecting a spinal deformity associated with adolescentidiopathic scoliosis. Later that day, she complained of lightnumbness in her right hand postoperatively [time to onsetnot clearly stated]. It was believed that the local anaestheticin the epidural solution was a potential cause. However,the epidural analgesia was maintained due to theseriousness of the surgery. On day 3, a paradoxical chestmovement was observed with diminished chest expansionon the right side. Resonant percussion was notedthroughout the right lung field with reduced air entry onauscultation. It was concluded that a unilateral blockade ofthe intercostal nerves was caused by unilateral migration ofthe epidural catheter.

The girl’s pain was controlled with alternative analgesicsand the epidural infusion was withdrawn. After severalhours, her chest movement improved significantly. Thenumbness in her right hand disappeared and air entry wasrestored.Sunderesan R, et al. Post-epidural unilateral paralysis of intercostal muscles inchild. Journal of the College of Physicians and Surgeons Pakistan 20: 408-9, No.6, Jun 2010 - United Kingdom 803042644

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Reactions 23 Oct 2010 No. 13240114-9954/10/1324-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved