Reactions 1274 - 17 Oct 2009

SRopivacaine

Heart arrest in an elderly patient: case reportAn 82-year-old woman had a heart arrest whilst

undergoing a sciatic nerve block with ropivacaine.The woman, who had a history of atrial fibrillation, was

scheduled for a toe osteophytosis excision. After receivingmidazolam, a parasacral in-plane approach to the sciaticnerve was conducted using ultrasound guidance. A tibialnerve response and negative aspiration tests wereobserved, then a mixture of 20mL of 0.5% ropivacaine andclonidine 50µg was injected over about 90 seconds.Immediately afterwards, she had speech difficulties,became unconscious and had a tonic clonic seizure.

The woman received thiopental, suxamethoniumchloride and oxygen and her seizure stopped. Ventricularfibrillation was observed 1 minute later and chestcompressions commenced; atrial fibrillation returned afterdefibrillation. She was treated with amiodarone, propofoland soya oil emulsion [intralipid] infusions and transferredto the ICU. Her ropivacaine blood concentration was2.48 mg/mL, 15 minutes post-injection. She had anuneventful recovery and was discharged withoutneurological sequelae.

Author comment: "The high blood level of ropivacainemay explain the severe signs of toxicity."Gnaho A, et al. Cardiac arrest during an ultrasound-guided sciatic nerve blockcombined with nerve stimulation. Regional Anesthesia and Pain Medicine 34: 278,No. 3, May-Jun 2009 - France 801154054

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Reactions 17 Oct 2009 No. 12740114-9954/10/1274-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved