Reactions 1176 - 3 Nov 2007

SRopivacaine

Tonic-clonic seizures in an elderly patient: casereport

A 76-year-old woman experienced a tonic-clonic seizureduring treatment with ropivacaine.

The woman, who had a history of multiple myeloma,experienced a pathological left proximal humerus fracture andan open reduction and internal fixation followed by radiationwas planned. She had a 4 × 4cm metastatic lesion on themedial end of her clavicle. Following noninvasive monitoringplacement and IV sedation, an interscalene catheter wasinserted and 25mLs of 0.3% ropivacaine and epinephrine wasinjected via catheter; she received a total ropivacaine dose of75mg. After every 5mLs of injection, frequent aspirations wereperformed. After 15 minutes of the block, she experienced atonic-clonic seizure.

The woman was intubated and ventilated. After her seizurehad abated, she had a venous ropivacaine concentration of3.68 µg/mL. The rest of her surgery was uneventful. Thefollowing day, an ultrasound evaluation of her interscaleneregion was performed and she received a dextrose injection.The catheter tip location was confirmed as around the plexus.Aspiration of the catheter was negative. The catheter wasremoved and she was discharged without sequelae.

Author comment: "Symptoms suggest the possibility ofropivacaine absorption via the tumor present in the vicinity.Other factors that could have influenced the absorptionkinetics of ropivacaine were advanced age, sedation used forblock placement and α-1-acid glycoprotein".Dhir S, et al. Ropivacine toxicity at clinical doses. 2007 Annual Meeting of theAmerican Society of Anesthesiologists (CD-ROM): abstr. 2033, 13 Oct 2007[abstract] - Canada 801084208

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Reactions 3 Nov 2007 No. 11760114-9954/10/1176-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved