Reactions 776 - 6 Nov 1999

Levobupivacaine

CNS disorders following inadvertent intravenousadministration in an elderly patient: case report

A 77-year-old woman experienced transient CNS disordersafter she accidentally received a large dose of levobupivacaine(142.5mg) intravenously instead of epidurally duringanaesthesia for elective surgery.

The patient received 3ml of levobupivacaine 0.75% withepinephrine 15µg injected as an epidural test dose. Fiveminutes later, she started to receive increments of theremaining 17ml of levobupivacaine 0.75%. Her BP and HRremained unchanged and she was communicative until thefinal 5ml of levobupivacaine was injected. At this time, thewoman became disoriented and drowsy and her speechbecame slurred. She then became excitable and agitated. Theepidural injection was immediately stopped; a total of 19ml oflevobupivacaine had been injected.

Suspecting an accidental intravenous injection, IV thiopentaland supplemental oxygen were administered and the patientstarted to breathe spontaneously. Within 10 minutes, she wasawake and oriented and had no recall of the events. Theepidural catheter was removed about 1cm and frank bloodcould be freely aspirated. Her serum levobupivacaineconcentrations were 2.7 and 1.1 µg/ml, respectively, in venousblood samples taken 14 and 120 minutes afterlevobupivacaine was discontinued.

The surgical procedure was completed under spinalanaesthesia using hypobaric tetracaine and epinephrine withno further complications. The patient was discharged onpostoperative day 4.

Author comment: ‘Our intent in reporting this case is towarn anesthesia providers that all local anesthetics arepotentially harmful, that levobupivacaine may be less toxicrelative to other local anesthetics, and that early recognitionand the rapid initiation of measures to prevent symptomprogression are the mainstays of therapy.’Kopacz DJ, et al. Accidental intravenous levobupivacaine. Anesthesia andAnalgesia 89: 1027-1029, Oct 1999 - USA 800803055

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Reactions 6 Nov 1999 No. 7760114-9954/10/0776-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved