Reactions 1434 - 12 Jan 2013

SRopivacaine

CNS toxicity, treated with soya oil emulsion: casereport

A 19-year-old man developed CNS toxicity, manifesting asvisual hallucinations and myoclonic movements, afterreceiving ropivacaine [time to onset not clearly stated]; he wassuccessfully treated with soya oil emulsion [Intralipid].

The man, who was scheduled for an ultrasound-guidedbrachial plexus block for an ulnar medial collateral ligamentrepair, received midazolam and an injection of 5mL of 0.5%ropivacaine. Ropivacaine was likely injected intravascularly aslocal anaesthetic spread was not visualised. The block needlewas then repositioned and a further 10mL of ropivacaine wasgiven. At this time, he had a sinus rhythm with an HR of 58bpmand a BP of 135/53mm Hg. He suddenly moved his head backand forth repeatedly, and stated that he was playing in abaseball game. His HR increased to 160bpm and his BP rose to190/89mm Hg.

The man was treated with 100mL (1.5 mL/kg) of 20% soyaoil emulsion as a single IV bolus over 1 minute, as well asoxygen and midazolam. He regained full orientation within2 minutes, with normalisation of his vital signs. His symptomsdid not recur.

Author comment: "In the June 2011 issue of the Journalof Anesthesia, Mizutani et al reported the treatment ofropivacaine-induced central nervous system (CNS) toxicitywith intravenous (IV) 20% lipid emulsion. . . We would like togive further support for the use of lipid emulsion in thiscontext by reporting a similar case."Nguyen VH, et al. Further support for the early administration of lipid emulsion inthe treatment of ropivacaine-induced central nervous system toxicity. Journal ofAnesthesia 26: 479-80, No. 3, Jun 2012. Available from: URL: http://dx.doi.org/10.1007/s00540-012-1331-8 - USA 803081658

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Reactions 12 Jan 2013 No. 14340114-9954/10/1434-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved