Reactions 1376 - 5 Nov 2011

SLevobupivacaine

Anaphylaxis: case reportA 25-year-old woman with a history of asthma developed

asthma following treatment with levobupivacaine.The woman underwent lumbar decompression and

microdiscectomy. After the operation, 3mL of MediShieldgel was applied to the exposed nerve root to reducepostoperative scarring. Following wound closure, 10mL of0.5% levobupivacaine [route not stated] was administeredfor postoperative analgesia. Within 5 minutes, her oxygensaturation decreased to 84%, her systolic BP dropped to72mm Hg and her airway pressures increased.Examinations revealed reduced air entry and expiratorywheeze, and wheals.

The woman was intubated and received ephedrine,chlorphenamine, hydrocortisone, fluids remifentanil,propofol and salbutamol [albuterol]. She was transferred tothe ICU, where she was sedated and received epinephrine[adrenaline] for 48 hours. Urticaria and wheals persistedfor 36 hours. She developed pneumonia during her ICUstay, however made a full recovery. Serum tryptase levelswere consistent with anaphylaxis. Subsequent allergytesting was positive for levobupivacaine (3mm wheal) andMediShield gel (1mm wheal).

Author comment: "We believe that the main trigger forthe reaction in this patient was levobupivacaine. Although theMediShield gel consistently produced a smaller, positivereaction to skin prick testing, it may have contributedsomething to the release of histamine."Gupta A, et al. Anaphylaxis secondary to levobupivacaine. Anaesthesia 66:942-944, No. 10, Oct 2011. Available from: URL: http://dx.doi.org/10.1111/j.1365-2044.2011.06815.x - United Kingdom 803062267

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Reactions 5 Nov 2011 No. 13760114-9954/10/1376-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved