Reactions 443 - 20 Mar 1993

Bupivacaine/lidocaine

Anaphylaxis after epidural administration: casereport

25 min after an epidural injection of 0.5% bupivacaine 18ml,a 27-year-old woman undergoing a repeat elective Caesareansection experienced an anaphylactoid reaction. Prior toinsertion of the epidural catheter, she was given 1% lidocaine2ml. The woman, who 2.5 years earlier, had developed anallergic rash 3 days after epidural anaesthesia withbupivacaine, now experienced tingling of the tongue, faintnessand vomiting. Her BP dropped, and she developed itching andgeneralised and pulmonary oedema. She was treated with IVfluids, oxygen, ephedrine, chlorphenamine andhydrocortisone. The Caesarean section was completed and theinfant, who was limp, cyanosed and had pulmonary oedema,was intubated. Maternal erythema and oedema improved andthe infant’s condition stabilised over the next 3 hours. Thepatient and infant were discharged 8 days postoperatively.Skin tests conducted 6 weeks after delivery gave a positivereaction to 2% lidocaine and a negative reaction tobupivacaine. Intradermal testing with both drugs at 1:10dilutions were negative.

Author comment: ‘This reaction ... may be considered as adelayed intravenous reaction. Whether the reaction was due tolignocaine (lidocaine) or bupivacaine is unclear ... theintradermal response to anaesthetic drugs can be unclear withfalse negatives.’Thomas AD, et al. Anaphylactoid reaction following local anaesthesia for epiduralblock. Anaesthesia 48: 50-52, Jan 1993 - England 800183298

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Reactions 20 Mar 1993 No. 4430114-9954/10/0443-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved