Reactions 1167 - 1 Sep 2007

Ropivacaine

Loss of consciousness and generalised seizures:case report

A 25-year-old woman developed loss of consciousness andgeneralised seizures after administration of ropivacaine foraxillary brachial plexus block.

The woman was scheduled for removal of a metal plate fromher left ring finger and lysis of adhesions with axillary brachialplexus block. Her skin was infiltrated with lidocaine. Anintravenous catheter was inserted, and 40mL of ropivacaine7.5 mg/mL, at a total dose of 300mg, was injected, withnegative aspirations every 5mL. After 5 minutes, sensory blockwas observed in her ulnar and median nerves. After10 minutes, sensory block was observed in her radial andmusculocutaneous nerves and complete motor block in hermedian, ulnar and musculocutaneous nerves. Thirteenminutes after the ropivacaine injection, she said that she beganto feel numbness in her lip. At that time, she lostconsciousness and suddenly convulsed. During the seizure,her HR increased from 85 beats/min to 140 beats/min and hersystolic BP increased from 104mm Hg to 160mm Hg.

The woman’s lungs were immediately ventilated with 100%oxygen by a mask. She received propofol to induce generalanaesthesia. After about 20 seconds, her seizure stopped.After 5 minutes, spontaneous respiration appeared graduallyand then changed to hyperventilation, with a tidal volume of12–15 mL/kg and a respiratory rate of 22–28 breaths/min. Alaryngeal mask airway was inserted. After a period ofobservation, surgery was performed under generalanaesthesia. Gradually, her HR started to decrease. At the endof surgery, it had normalised to 85 beats/min. Generalanaesthesia was stopped 72 minutes after her seizure, andafter confirmation of consciousness, the laryngeal mask airwaywas removed. She had no awareness of the incident and nosequelae. A venous blood sample, taken 28 minutes after theropivacaine injection, revealed a total plasma ropivacaineconcentration of 3.65 µg/mL.

Author comment: The patient’s symptoms could havebeen caused by "an overdose of ropivacaine, though no directproof of this exists".Kimura Y, et al. Ropivacaine-induced toxicity with overdose suspected afteraxillary brachial plexus block. Journal of Anesthesia 21: 413-416, No. 3, Aug 2007- Japan 801092416

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Reactions 1 Sep 2007 No. 11670114-9954/10/1167-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved