Reactions 1491, p13 - 8 Mar 2014

★Bupivacaine/lidocaine

Parotitis (first report with bupivacaine): 3 casereports

Three women 30–45 years of age developed parotitis afterepidural anaesthesia with bupivacaine (two patients) orlidocaine (one patient).

A 37-year-old woman underwent breast surgery andabdominoplasty. She received a thoracic block with fentanyland 13mL of 0.5% bupivacaine, and a lumbar block withfentanyl and 25mL of 0.5% bupivacaine. Four hours aftersurgery, she developed painless bilateral parotid swellingwithout palpable crepitus; she had not experienced strainingor coughing. She had received 2L of fluids during surgery, 1Lpostoperatively before parotitis onset, and 1.5L prior todischarge, while her urine output was 1.5L during surgery,0.7L postoperatively before parotitis onset and 1.1L untilhospital discharge. Her oedema completely resolved within12 hours.

A 45-year-old woman underwent breast implantation andbody contouring. She received a thoracic block with fentanyland 10mL of 0.5% bupivacaine [Marcaine], and a lumbar blockwith fentanyl and 20mL of 0.5% bupivacaine. Three hours aftersurgery, she developed painless bilateral parotid swellingwithout palpable crepitus; she had not experienced strainingor coughing. She had received 5L of fluids during surgery, 1Lpostoperatively before parotitis onset, and 3L prior todischarge, while her urine output was 2L during surgery, 0.5Lpostoperatively before parotitis onset and 1.5L until hospitaldischarge. Her parotitis had completely resolved in 36 hours.

A 30-year-old woman underwent breast implantation andliposuction. She received a thoracic block with fentanyl and10mL of 1% lidocaine, and a lumbar block with 10mL of 1%lidocaine. Five hours after surgery, she developed painlessbilateral parotid swelling without palpable crepitus; she hadnot experienced straining or coughing. She had received 2L offluids during surgery, 1.2L postoperatively before parotitisonset, and 3.3L prior to discharge, while her urine output was1L during surgery, 0.5L postoperatively before parotitis onsetand 1.5L until hospital discharge. Her parotitis had completelyresolved in 48 hours without sequelae.

Author comment: "The occurrence of parotitis in patientsundergoing surgery under epidural anesthesia is a novelsituation, which increases the range of possible etiologies forthis little known condition. Dehydration leading to transientparotid secretion obstruction may play a significant role.Further reports of parotitis occurring after surgery in theregional anesthesia setting may help to elucidate itspathophysiology."Rosique MJF, et al. Parotitis after epidural anesthesia in plastic surgery: Report ofthree cases. Aesthetic Plastic Surgery 37: 838-842, No. 4, Aug 2013 -Brazil 803100098

» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of parotitisassociated with bupivacaine. The WHO ADR database did notcontain any reports of parotitis associated with bupivacaine.

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Reactions 8 Mar 2014 No. 14910114-9954/14/1491-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved