Reactions 1092 - 11 Mar 2006

Ropivacaine

Peripheral nerve disorders after continuousinterscalene block: case report

A 43-year-old woman developed partial sensory and motordeficit of the ipsilateral lower limb after interscalene brachialplexus block with ropivacaine during left rotator cuff repair.

Interscalene block was initiated with 0.5% ropivacaine 2mLinjected directly, followed by 0.5% ropivacaine 18mLadministered via a catheter, then general anaesthesia wasinduced. Postoperatively, the woman received patient-controlled interscalene analgesia with a continuous infusion of0.2% ropivacaine 5 mL/h and a 10mL bolus with a 60 minutelockout. She also received paracetamol [acetaminophen] andmorphine. Twelve hours after initiation of interscalene block,she unintentionally removed the catheter, after which hershoulder became progressively painful. Motor and sensoryblockade had resolved completely the next morning. A secondleft continuous interscalene block was performed with 0.5%ropivacaine 20mL injected directly. Sensory and motor blockwas achieved. Approximately 6 hours later, afteradministration of 0.2% ropivacaine 30mL, she reportedweakness and decreased sensation in her left leg.

Interscalene analgesia was discontinued. On examination2 hours later, the woman had complete sensory and motorblock of the left arm, hypoesthesia of the left hemibody andnumbness and warmth of the left side of her face. A CT scanshowed contact between the tip of the catheter and theepidural space; the catheter was removed. Six hours afterropivacaine discontinuation, the woman’s symptoms hadresolved completely and she was discharged on postoperativeday 5.Faust A, et al. Partial sensory and motor deficit of lpsilateral lower limb aftercontinuous interscalene brachial plexus block. Anesthesia and Analgesia 102:288-290, No. 1, Jan 2006 - Switzerland 801033454

1

Reactions 11 Mar 2006 No. 10920114-9954/10/1092-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved