Reactions 1197 - 12 Apr 2008

SMepivacaine

Seizures following inadvertent vascular puncture:case report

A 27-year-old man developed seizures due to inadvertentvascular puncture during ultrasound-guided axillary blockusing mepivacaine.

The man, who had been admitted because of a penetratingtrauma of his right hand, underwent brachial plexus block. Themedian nerve was approached first. Following two negativeaspiration test results, he received two 4mL boluses ofmepivacaine 2%. The radial nerve was then approached; hereceived two boluses of 4mL of the same solution followingnegative aspiration test results. The ulnar nerve was thenapproached, and the injection initiated according to the sameprotocol. At that time, about 4 minutes after the first injection,he became unresponsive and agitated and developed perioralmyoclonias.

The injection was immediately discontinued and the needlewithdrawn. About two minutes after seizure onset, the manwas intubated after receiving thiopental sodium andsuxamethonim chloride. His seizures ceased and oxygensaturation was found to be 100%. Sinus rhythm and rarepremature ventricular beats were observed. He was stableunder general anaesthesia with sevoflurane in oxygen and adecision was made to continue with his surgery. He recoveredwithout complications.

Author comment: "In this case . . . intravascular injectionwas likely. The time interval between injection and seizurewas short and probably incompatible with local absorption ofthe drug . . . The two first injections had distorted theanatomy of the axilla, and the veins were probably displacedor compressed by the local anesthetic, making theirvisualization more difficult."Zetlaoui PJ, et al. Ultrasound guidance for axillary plexus block does not preventintravascular injection. Anesthesiology 108: 761, No. 4, Apr 2008 -France 801103683

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Reactions 12 Apr 2008 No. 11970114-9954/10/1197-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved