Reactions 1385 - 21 Jan 2012

Ropivacaine

Vocal cord palsy in an elderly patient: case reportA 65-year-old man with haemopneumothorax with

second-to-fifth rib fractures on the right side developedvocal cord palsy resulting in aphonia after receivingropivacaine for pain relief.

The man received an epidural thoracic paravertebralblock with 15mL of 0.5% ropivacaine (0.3 mL/kg) and,25 minutes later, he developed speech difficulty. Hisspeech volume decreased gradually, leading to completeaphonia within 15-20 minutes. He did not have respiratorydifficulty, and involvement of his right recurrent laryngealnerve due to ropivacaine was suspected.

The man was closely monitored and was kept nil orallyand, after 7 hours, his voice started to recover. His speechhad fully recovered 30 minutes later.

The man then received ropivacaine 0.2% at 5 mL/hr alongwith fentanyl and epinephrine [adrenaline], which wasincreased to 7 mL/hr on the third day. A few hours later, heagain developed aphonia and the infusion wassubsequently discontinued. Indirect laryngoscopy showedflaccid paralysis of the right vocal cord; aphonia resolvedover 1 hour.

Author comment: ". . . the most likely cause of theaphonia was the ropivacaine administered into theparavertebral space. Moreover, there were no other obviouscauses of transient aphonia."Mohta M, et al. Vocal cord palsy: an unusual complication of paravertebral block.Anaesthesia and Intensive Care 39: 969-71, No. 5, Sep 2011 - India 803065895

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Reactions 21 Jan 2012 No. 13850114-9954/10/1385-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved