Reactions 1358 - 2 Jul 2011

Bupivacaine/ropivacaine/sufentanil

Neuromuscular deficits, hypotension andheadache following inadvertent intrathecaladministration: case report

A 30-year-old pregnant woman experiencedneuromuscular deficits, hypotension and headachefollowing inadvertent intrathecal administration ofbupivacaine, ropivacaine and sufentanil for analgesiaduring labour.

The woman underwent placement of a peridural catheterat the L3/4 level. Placement was impeded by extremelumbar lordosis and scoliosis, but was successful afterthree attempts. An aspiration test was unremarkable, and atest dose of 0.5% bupivacaine 1.5mL (7.5mg) wasadministered. She reported a mild warm feeling in her legs,but no motor block. A patient-controlled analgesia (PCA)pump with ropivacaine 1.5 mg/mL and sufentanil0.75 µg/mL was then attached, delivering 4mL boluses asneeded with 30 minutes lock-off time. Approximately30 minutes after PCA placement, she activated the firstbolus with immediate improvement of labour pain.However, progressive sensation disturbances from the T4level developed over the next 10 minutes, in addition tomotor deficits in her legs and hypotension of 85/60mm Hg;her HR was 97 beats/min.

The PCA was immediately discontinued, and the filterwas closed. The woman was informed about the risks ofintrathecal analgesia, and remained under closeobservation. After 135 minutes, all her neurologicalsymptoms had resolved. She then received an intrathecalbolus of 0.125% bupivacaine 3mL with sufficient pain reliefand minimal impact on motor function or sensibility. Nofurther analgesia was required and she gave birth to ahealthy boy. The catheter was removed on postpartalday 1; over the next 48 hours, she developed mild frontalheadaches scoring 3/10 on a visual analogue scale. Thepain was aggravated by NSAIDs, fluids and bed-rest, andblood patch was performed on postpartal day 3. Hercomplaints immediately ceased, and she was dischargedhome the following day.Aust H, et al. Epidural anesthesia in obstetrics: an accidentally placed intrathecalcatheter--remove it or use it?. Zeitschrift fur Geburtshilfe und Neonatologie 214:249-51, No. 6, Dec 2010 [German] - Germany 803056414

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Reactions 2 Jul 2011 No. 13580114-9954/10/1358-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved