Reactions 804 - 3 Jun 2000

SBupivacaine

Hypoglycaemia following epidural administration:case report

A 30-year-old pregnant woman, who underwent inductionof labour at 38.5 weeks’gestation, developed hypoglycaemiaduring epidural analgesia using bupivacaine.

An epidural needle was inserted at the L3-4 interspace and atest dose of lidocaine was negative for signs of intrathecal or IVadministration. The woman was then given 5ml of bupivacaine0.25% and was pain-free within 15 minutes. Approximately 75minutes later, she required further pain relief and after anothernegative test dose, 5ml of bupivacaine 0.25% was injected.After approximately 10 minutes, she became light-headed,with facial tingling and lethargy. She then became stuporousand an immediate fingerstick test showed a blood glucoselevel of 18 mg/dl.

The patient received 50% IV dextrose and her mental statusimproved immediately. At this time, her blood glucose levelwas 223 mg/dl. She underwent an uneventful delivery and,approximately 1 hour postpartum, a repeat blood glucose levelwas 40 mg/dl, but she was asymptomatic. Her infant’s glucoselevel was normal over the next 24 hours. Postpartum follow-upshowed that the patient had no abnormalities in her glucosetolerance, insulin level, cortisol level or thyroid function. Shewas advised to have her blood glucose levels closelymonitored during any subsequent pregnancies.

Author comment: ‘This is not the first report ofhypoglycaemia during labour, but this is the first report of ahealthy parturient who suffered profound symptomatichypoglycaemia under epidural analgesia. . . . The specificcontribution of epidural analgesia to maternal hypoglycaemiawarrants further study.’Jacobs JS, et al. Severe hypoglycemia after labor epidural analgesia. Anesthesiaand Analgesia 90: 892-893, Apr 2000 - USA 800825188

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Reactions 3 Jun 2000 No. 8040114-9954/10/0804-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved