Reactions 958 - 5 Jul 2003

★Fentanyl/bupivacaine

Dysphagia and first report of aphonia with fentanylfollowing subarachnoid injection: case report

A 21-year-old woman who was in labour at 37 weeks’gestation experienced transient aphonia and dysphagiaimmediately after the induction of spinal epidural analgesiawith fentanyl and bupivacaine.

The woman received a subarachnoid injection of fentanyl10.25g combined with bupivacaine 2.5 mg and, approximately4 minutes later, her voice became increasingly weak and shesubsequently lost the ability to talk or swallow. Her vital signsremained stable and she remained alert and able to followcommands. No treatment was required and, approximately 20minutes after the onset of aphonia and dysphagia, sheregained the ability to talk and swallow.

Author comment: "The timing of onset of the transient lossof the ability to speak (aphonia) or swallow (aphagia)experienced by our patient seems consistent with extensivecephalad spread of fentanyl injected into the subarachnoidspace."Kuczkowski KM, et al. Transient aphonia and aphagia in a parturient followinginduction of combined spinal-epidural labor analgesia with subarachnoid fentanyland bupivacaine. Anesthesiology 98 (Suppl. 1): 62, Apr 2003 - USA 800940881

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of aphonia associated withfentanyl. The WHO Adverse Drug Reactions database containedfour reports of dysphonia associated with fentanyl.

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Reactions 5 Jul 2003 No. 9580114-9954/10/0958-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved