Reactions 699 - 2 May 1998

Ropivacaine

Seizure: case reportA 13-year-old boy had a generalised grand mal seizure

following the administration of the local anaestheticropivacaine.

The boy, who had a history cerebral palsy, had chronic painsecondary to bladder spasm and was referred for an epiduralinfusion of local anaesthetic. His usual medications includedbaclofen and diazepam. Immediately following theadministration of 2ml of ropivacaine 10mg/ml overapproximately 15 seconds, he asked whether his face shouldbe feeling ‘different’. Within 1 minute, he had a classical grandmal seizure. The boy was resuscitated with oxygen via a bagand mask and he received IV midazolam. The seizure lasted for2 minutes and an ECG performed in the recovery area revealedsinus tachycardia with an intraventricular conduction defect. Aserum ropivacaine concentration of 1.4 mg/L was determined,which would have been consistent with inadvertentintravascular injection; his plasma concentration at the time ofthe seizure would have been much higher (6–30 mg/L).

Author comment: ‘Several factors may have altered theseizure threshold in our patient including the concomitant useof other drugs.’ This patient was receiving baclofen, whichmight lower the threshold of seizures in susceptible patients.However, the boy was also receiving diazepam, which could beexpected to increase the threshold for seizure activity.’Plowman AN, et al. Central nervous system toxicity attributable to epiduralropivacaine hydrochloride. Anaesthesia and Intensive Care 26: 204-206, Apr 1998- Australia 800660540

» Editorial comment: A search of AdisBase and Medlinerevealed only 1 previous case report of seizures in associationwith ropivacaine [see Reactions 679: 11, 29 Nov 1997;800627395].

1

Reactions 2 May 1998 No. 6990114-9954/10/0699-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved