Reactions 1253 - 23 May 2009

★ SRopivacaine

Acute renal failure (first report) followinghaemorrhoidectomy?: case report

A 61-year-old woman with obstructive uropathydeveloped acute renal failure, after undergoing ahaemorrhoidectomy using ropivacaine as local regionalanaesthesia.

The haemorrhoidectomy was carried out under generalanaesthesia using sufentanil, ketamine and propofol;anaesthesia was maintained using sevoflurane.Postoperative analgesia was achieved via a bilateral nervestimulator-guided pudendal block using 200mg ofropivacaine 5 mg/mL (total volume 40mL), along withparacetamol [acetaminophen], tramadol and NSAIDs. Thewoman was discharged home 48 hours later. Onpostoperative day 10, she suffered abdominal pain andelevated BP, for which she was prescribed a calciumchannel antagonist. Two days later, she complained ofdysuria, pelvic pain and a sense of urgency. She wasadmitted to the ICU with acute renal failure andhyperkalaemia. Substantial bladder distension was evidenton an abdominal ultrasound. She was diagnosed withsevere obstructive renal failure due to bladder distension.She appeared to have had a bladder control problem sinceher surgery, but further investigations revealed a pre-existing obstructive uropathy that had decompensated as aresult of the surgery and the pudendal block.

Within an hour of her admission, the woman wascommenced on haemodialysis and drug therapy. She hadexcellent clearance of nitrogen waste products, and heroutcome was favourable. She was discharged from the ICUon hospital day 2 without requiring any furtherhaemodialysis.

Author comment: It is not possible to come to aconclusion whether to implicate the surgical procedure or thelocoregional anaesthesia in the development of this episodeof renal failure associated with severe postoperative urinaryretention.Fayolle-Pivot L, et al. Acute renal failure related to urinary retention followinghaemorrhoidectomy performed under general anaesthesia and bilateral pudendalnerve block: a case report. Annales Francaises d’Anesthesie et de Reanimation 27:1019-1022, No. 12, Dec 2008 - France 801141264

» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of renalfailure associated with ropivacaine. The WHO ADR databasecontained two reports of renal failure acute (WHO-ART)associated with ropivacaine.

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Reactions 23 May 2009 No. 12530114-9954/10/1253-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved