Reactions 967 - 6 Sep 2003

SLevobupivacaine

Tonic clonic seizures in elderly patients: 2 casereports

A 71-year-old woman and a 66-year-old man developedtonic clonic seizures following the administration oflevobupivacaine for anaesthetic lumbar plexus blockade.

Both patients had a history of hypertension and atrialfibrillation and had received midazolam and fentanyl forsedation before administration of a posterior lumbar plexusblock for elective lower limb surgery. The man and womanreceived 35mL and 30mL, respectively, of levobupivacaine0.5% with epinephrine in divided doses over 90 seconds.Within 1 minute of completing the injection, both patients haddeveloped tonic clonic seizures. Both patients weresuccessfully treated with thiopental sodium, and the womanalso received midazolam and suxamethonium chloride tofacilitate tracheal intubation. Neither patient developedcardiovascular toxicity, and both underwent uneventfulprocedures under general anaesthesia.

Author comment: "In both cases, the seizure occurredimmediately after local anesthetic injection, suggesting that itwas a result of unintentional intravascular administration oflevobupivacaine."Breslin DS, et al. Central nervous system toxicity following the administration oflevobupivacaine for lumbar plexus block: a report of two cases. RegionalAnesthesia and Pain Medicine 28: 144-147, Mar-Apr 2003 - USA 800942039

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Reactions 6 Sep 2003 No. 9670114-9954/10/0967-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved