Reactions 1227 - 8 Nov 2008

★Ropivacaine

First report of decubitus ulcer: 2 case reportsTwo women developed decubitus ulcers after receiving

ropivacaine as anaesthesia during myomectomies for uterineleiomyomas [time to reaction onset not clearly stated].

A 32-year-old woman was administered 0.2% ropivacainecontinuously at 4 mL/hr, followed by continued epiduralanaesthesia for 12 hours postsurgery for pain relief. Aftersurgery, her body position was changed every 2 hours. Shecomplained of hip pain 12 hours after the operation, and onday 4 she was observed to have reddish-violet erythema, apalpable soft tissue mass, vesicles and hyperaesthesia in thesacral region; her heels also displayed vesicles.Betamethasone was injected, and on day 3 the soft tissue masswith regional pain resolved. She was discharged home onday 8.

A 33-year-old woman received 0.2% ropivacainecontinuously at 4 mL/hr, with epidural anaesthesia continuingas pain relief for 12 hours after the operation. Herpostoperative wound pain was too severe for her to changebody position, and 8 hours after surgery she developed hippain. The next day, a hard mass with redness appeared, andshe reported severe pain and hyperaesthesia. Blood testsindicated mild inflammation. On day 3, betamethasone wasinjected, and the redness and mass gradually disappeared byday 7. She was discharged home on day 8 with continuing mildpain, and this persisted until day 21.

Author comment: "[E]pidural anesthesia was used for anadditional 12 h for postoperative pain relief. This extensiveuse of epidural anesthesia could be an additional factor thatcould induce decubitus. Epidural anesthesia inhibits motorfunction, resulting in insufficient peripheral blood circulationwhich could cause pressure ulcers."Takahashi E, et al. Two cases of epidural anesthesia-associated postoperativedecubitus. Journal of Obstetrics and Gynaecology Research 34 (Suppl.): 700-702,No. 4, Part 2, Aug 2008 - Japan 801124436

» Editorial comment: A search of AdisBase, Medline, Embaseand the WHO Adverse Drug Reactions database did not revealany previous case reports of decubitus ulcer associated withropivacaine.

1

Reactions 8 Nov 2008 No. 12270114-9954/10/1227-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved