Reactions 772 - 9 Oct 1999

Bupivacaine/ropivacaine

Motor blockade following epidural administration:2 case reports

Two women, aged 32 and 30 years, experienced profoundand prolonged motor blockade after they received patient-controlled epidural analgesia with ropivacaine followingcombined spinal/epidural anaesthesia with standard-dosebupivacaine for elective caesarean section.

Both patients received uncomplicated combined spinal/epidural anaesthesia with 2.6ml of hyperbaric 0.5%bupivacaine. Surgery was uneventful in both patients andpatient-controlled analgesia with 0.1% ropivacaine 3 ml/h witha 5ml bolus and 15 minute lock-out commenced in therecovery room before the spinal anaesthetic had regressed.

The first patient noted no reduction in pain over the next 12hours, and her highest pain score was recorded 6 hourspostoperatively. Two hours later, she was still unable to moveher legs and ankles and ropivacaine analgesia was stoppedafter 11 hours (total dose 137.4mg). One hour later, she wasfully mobilised.

The second patient experienced severe motor block 4 hoursafter she started ropivacaine analgesia and noted increasinglysevere pain between 4 and 8 hours postoperatively. At 8 hourspostoperatively, she had received a total dose of 55.6mg ofropivacaine; this agent was stopped 1 hour later. Her motorblock resolved within 3–4 hours.

Both patients received IV patient-controlled morphine inplace of ropivacaine and no further sequelae were observed.

Author comment: ‘It is not clear whether epiduralropivacaine may interact with intrathecal bupivacaine toprolong the effect of the latter on motor fibres in particular, butlaboratory investigation of this hypothesis seems warranted.’Buggy DJ, et al. Profound motor blockade with epidural ropivacaine followingspinal bupivacaine. Anaesthesia 54: 895-898, Sep 1999 - England 800791789

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Reactions 9 Oct 1999 No. 7720114-9954/10/0772-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved