Reactions 942 - 15 Mar 2003

★Levobupivacaine

First report of seizures following axillary brachialplexus blockade: case report

Axillary brachial plexus blockade with levobupivacaine formanipulation and wiring of a fractured distal radius wasassociated with a self-limiting seizure in a 60-year-old woman.She had no previous history of seizures.

The woman underwent induction of general anaesthesiawith alfentanil and propofol, followed by maintenanceanaesthesia with isoflurane and nitrous oxide in oxygen. Shewas also treated with IV ondansetron. Axillary brachial plexusblock was then performed, following negative aspiration, usinga 50mm insulated regional block needle with 30mL oflevobupivacaine 0.375% (125mg); aspiration was repeatedafter the injection of 10, 20 and then 30mL of levobupivacaine.

Approximately 30 seconds after the levobupivacaineinjection was completed, the woman experienced ageneralised grand mal seizure that resolved spontaneouslyafter about 30 seconds. She was treated with IV midazolam toprevent further seizures and surgery was continued. Thewoman recovered uneventfully and was discharged later thatday.

Author comment: "We postulate that some or all of the localanaesthetic was inadvertently injected intravascularly."Pirotta D, et al. Convulsions following axillary brachial plexus blockade withlevobupivacaine. Anaesthesia 57: 1187-1189, No. 12, Dec 2002 -England 800929381

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of seizures associated withlevobupivacaine therapy. The WHO Adverse Drug Reactionsdatabase contained four reports of convulsions associated withlevobupivacaine.

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Reactions 15 Mar 2003 No. 9420114-9954/10/0942-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved