Reactions 963 - 9 Aug 2003

SLevobupivacaine/lidocaine

Seizures, tachycardia and hypertension followinginadvertent intravascular injection: case report

Inadvertent intravascular injection of levobupivacaine andlidocaine occurred in a 35-year-old man during axillarybrachial plexus block for orthopaedic surgery. No significantcardiovascular effects occurred.

Following midazolam premedication, the man received anaxillary plexus block by the transarterial approach with 20mLof lidocaine 2% mixed with 20mL of levobupivacaine 0.75%;25mL was injected posterior to and 15mL was injected anteriorto the axillary artery. Soon after, he had three interruptedepisodes of tonic-clonic seizures which each lasted for about 3seconds. He then became unconscious, he had sinustachycardia (160 beats/min), a BP of 180/120mm Hg, and hisSPO2 decreased to 40% within 1 minute.

The man was treated with midazolam and propofol tocontrol seizures, and he was ventilated with 100% oxygen andintubated. Within 30 minutes, his vital signs had stabilised andhe was extubated. Two hours later, he was alert and oriented,so was discharged. He did not have any evidence of sensoryand motor blockade.

Author comment: "Racemic bupivacaine, when injectedintravascularly, is associated with serious cardiac complications. . . It appears that levobupivacaine is a safer drug than racemicbupivacaine."Khan H, et al. Accidental intravascular injection of levobupivacaine and lidocaineduring the transarterial approach to the axillary brachial plexus. Canadian Journalof Anesthesia 50: 95, Jan 2003 - USA 800923311

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Reactions 9 Aug 2003 No. 9630114-9954/10/0963-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved