Reactions 1438 - 9 Feb 2013

SLevobupivacaine/ropivacaine

Anaphylaxis in an elderly patient: case reportA 74-year-old man developed anaphylaxis after receiving

levobupivacaine, and subsequently after receiving ropivacaine.During a carotid endarterectomy, the man underwent a

cervical plexus block with 22mL of 0.5% levobupivacaine,delivered by repeated injections [dosage informationincomplete]. A few minutes later, he developed a convulsiveseizure, cutaneous flushing, cognitive dysfunction andcardiovascular collapse with tachycardia and hypotension. Hedid not respond to ephedrine or phenylephrine. Drugoverdose was suspected, and he received lipids. His consciouslevel and cardiovascular instability rapidly improved. Surgerywas postponed, and he was admitted to an ICU, where hereceived norepinephrine [noradrenaline], bisoprolol andamlodipine.

Fifteen days later, the man underwent rescheduledendarterectomy. Cervical plexus block was performed with0.5% ropivacaine. After injection of 7mL [dosage informationincomplete], he developed facial erythema and cardiovascularcollapse. He received ephedrine, and his BP improved.Regional anaesthesia was discontinued, and blood sampleswere taken for tests. He was diagnosed with immediate-typeallergic reaction. Six weeks later, skin testing revealed positivereactions to levobupivacaine and ropivacaine [outcome notclearly stated].

Author comment: "The results of this testing suggest thatthe patient suffered from an immediate-type allergic reactionto both ropivacaine and levobupivacaine. . . An additionalinterest in this case, lies in crossreactivity between ropivacaineand levobupivacaine."Calderon AL, et al. Immediate allergic cross-reactivity to levobupivacaine andropivacaine. Anaesthesia 68: 203-205, No. 2, Feb 2013. Available from: URL:http://dx.doi.org/10.1111/j.1365-2044.2012.07314.x - France 803083015

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Reactions 9 Feb 2013 No. 14380114-9954/10/1438-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved