Reactions 1500, p34 - 10 May 2014

SRopivacaine

Systemic toxicity: case reportA 57-year-old man developed systemic toxicity while

receiving ropivacaine; he later died.The man, who had end-stage renal disease and impaired

liver function, underwent a below-knee amputation.Ropivacaine catheters were placed postoperatively, and helater became bradycardic and lethargic with dysgeusia,tinnitus and hallucinations [duration of treatment to reactiononsets not stated]. EKG showed widened QRS and prolongedQT without ST changes. An ejection fraction of 20% was foundon echocardiography; there was no wall motion abnormality.He had received an estimated infusion of ropivacaine 1540mg.

The man received one round of plasmapheresis and 20%soya oil emulsion [intralipids], with a transient response. Hesubsequently died of cardiac arrest.

Author comment: "We have evidence of ropivacainetoxicity considering the Naranjo algorithm score of 6, whichcorrelates to the category of a probable adverse drugreaction."Bazerbachi F, et al. Intravenous lipid rescue and ropivacaine systemic toxicity.Journal of Anesthesia 28: 139, No. 1, Feb 2014. Available from: URL: http://doi.org/10.1007/s00540-013-1669-6 - USA 803102784

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