Reactions 1341 - 5 Mar 2011

SRopivacaine

Clonic seizure and hypotension, treated withsoya oil emulsion: case report

A 40-year-old woman developed a clonic seizure andhypotension after receiving ropivacaine. She wassuccessfully treated with soya oil emulsion [Intralipos].

The woman was scheduled to undergo a laparoscopy-assisted myomectomy of the uterus. She was induced withpropofol and remifentanil, then received rocuroniumbromide and was intubated. A bilateral transversusabdominis plane block was performed for analgesia of theabdominal wall, with 40mL of 0.375% ropivacaine beingadministered (total dose: 150mg). The operation wascompleted under continuous fentanyl administration. Sheregained consciousness 149 minutes after the ropivacaineinfusion and was extubated. Upon returning to the ward,170 minutes after the infusion, she became unresponsiveand was pale-faced with cold limbs. Her BP was106/61mm Hg, her HR was 59 beats/min and her pulseoximetry was 98%. Patient-controlled analgesia (PCA) wasstopped and oxygen administration was increased.Administration of naloxone produced no change to hersymptoms. Tremors in her limbs were suggestive of a weakclonic seizure. Her BP dropped to 78/57mm Hg and shereceived etilefrine. After receiving diazepam, there was atransient improvement in her condition. However, a fewminutes later, her symptoms returned. Late-onset systemictoxicity was diagnosed.

The woman was intubated and started receiving 20%soya oil emulsion as a rapid infusion in 10mL increments.After receiving 100mL of soya oil emulsion, her seizuresdisappeared and she became responsive. She hadimproved skin colour and her BP recovered and stabilised.She received a further 100mL of soya oil emulsion at20 mL/h, after which her symptoms had not recurred andshe was fully conscious. She received a total of 230mL of20% soya oil emulsion. Upon regaining consciousness, shereported pain, for which she received flurbiprofen axetiland resumed PCA. There were no blood test orneurological abnormalities following her surgery or afterdischarge from hospital.Sakai T, et al. Ropivacaine-induced late-onset systemic toxicity after transversusabdominis plane block under general anesthesia: Successful reversal with 20%lipid emulsion. Masui. The Japanese Journal of Anesthesiology 59: 1502-1505, No.12, Dec 2010 [Japanese; summarised from a translation] - Japan 803050500

1

Reactions 5 Mar 2011 No. 13410114-9954/10/1341-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved