Reactions 1044 - 26 Mar 2005

★ SLevobupivacaine

First report of subdural blockade following epiduraladministration in an elderly patient: case report

A 72-year-old woman developed subdural blockade afterreceiving epidural levobupivacaine for postoperativeanalgesia.

The woman underwent uneventful elective lumbar spinaldecompression for spinal stenosis, with placement of anepidural catheter under direct vision at the end of theprocedure. Following administration of 7mL oflevobupivacaine 2.5 mg/mL via the epidural catheter,neuromuscular blockade was reversed with glycopyrroniumbromide and neostigmine. She was fully conscious on transferto the recovery area, and had a BP of 190/110mm Hg.However, 15 minutes later her level of consciousnesssuddenly decreased and her breathing became shallow.Examination revealed a good twitch response to train-of-fourstimuli and her pupils were equal and reactive, but she wasunresponsive to pain stimuli, and deep tendon reflexes wereabsent bilaterally. Approximately 30 minutes later, her oxygensaturation decreased to 90% and her breathing becameincreasingly shallow; she had a BP of 180/85mm Hg and a HRof 110 beats/min at this time.

The woman was intubated, and received propofol andvecuronium bromide. Her BP subsequently decreased to80/50mm Hg and she received metaraminol, after which herBP stabilised and her HR decreased to 80 beats/min. Sedationwas maintained over the next 5 hours with isoflurane andnitrous oxide. On discontinuation of sedation, she regainedconsciousness and made an unremarkable postoperativerecovery, with no neurological sequelae.D’agapeyeff A, et al. Unexpectedly high block following epidural catheterplacement under direct vision: a case report. Anaesthesia and Intensive Care 33:128-130, No. 1, Feb 2005 - England 800967774

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of subdural blockadeassociated with levobupivacaine. The WHO Adverse DrugReactions database contained one report of neuropathyassociated with levobupivacaine.

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Reactions 26 Mar 2005 No. 10440114-9954/10/1044-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved