Reactions 1182 - 15 Dec 2007

SRopivacaine

Neurotoxicity in an elderly patient: case reportA 76-year-old woman developed neurotoxicity following

administration of ropivacaine for brachial plexus block.The woman sustained a pathological fracture of her left

proximal humerus and was scheduled for open reduction andinternal fixation. She received fentanyl and midazolam forsedation, followed by lidocaine. An interscalene brachialplexus catheter was placed and 25mL of ropivacaine (75mg,0.3% with epinephrine [adrenaline] 2.5 µg/mL, 1.97 mg/kg)was administered in aliquots. About 15 minutes later, shesuddenly became unresponsive and had a generalised tonic-clonic seizure.

The woman received propofol and suxamethonium chloride[succinylcholine chloride]. She was intubated and ventilatedwith 100% oxygen. Following recovery from suxamethoniumchloride, the seizure did not recur. Surgery was completeduneventfully. After the operation, she had no recollection ofthe seizure. She had complete motor and sensory block of herbrachial plexus, which resolved over the following 24 hours.On postoperative day 1, ultrasound excluded intravascularcatheter placement. The plasma ropivacaine concentrationwas 3.68 µg/mL at 20 minutes after the block. She wasdischarged and had no sequelae at 3-month follow-up.Dhir S, et al. Case report: ropivacaine neurotoxicity at clinical doses in interscalenebrachial plexus block. Canadian Journal of Anesthesia 54: 912-916, No. 11, Nov2007 - Canada 801097728

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Reactions 15 Dec 2007 No. 11820114-9954/10/1182-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved