Reactions 679 - 29 Nov 1997

★ SRopivacaine

First report of seizures in an elderly patient: casereport

A 66-year-old woman experienced seizures followingtreatment with ropivacaine prior to acromioplasty.

The woman was to receive an interscalene brachial plexusblock for intra- and postoperative analgesia. A needle wasinserted into the interscalene groove and, following thenegative aspiration of blood, she received a test dose ofropivacaine 0.75% 2ml without any adverse effects, followedby the slow injection of a further 18ml of 0.75% ropivacaine(total dose 2.3 mg/kg).

Immediately after the slow injection, the womanexperienced clonic spasms of her facial muscles and she lostconsciousness. She experienced a second seizure soonafterwards. She was treated with IV thiopental sodium andbag-mask ventilation. She was given suxamethonium chloride,and later rocuronium bromide to facilitate tracheal intubation.Surgery was abandoned. While being transferred to herhospital bed, the woman regained consciousness. It wasdecided to continue surgery and the woman did notexperience any further complications.

Author comment: Despite the negative aspiration of bloodprior to the administration of ropivacaine, it is probable that theagent was injected directly into a vessel. ‘There are no publishedcases of convulsions in humans with the use of ropivacaine.’When potentially toxic doses of local anaesthetics are used, anincremental injection technique with adequate delay betweenbolus doses should be used to allow detection of any adverseeffects.Korman B, et al. Convulsions induced by ropivacaine during interscalene brachialplexus block. Anesthesia and Analgesia 85: 1128-1129, Nov 1997 -Australia 800627395

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Reactions 29 Nov 1997 No. 6790114-9954/10/0679-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved