Reactions 1398 - 21 Apr 2012

SRopivacaine

CNS toxicity: 2 case reportsTwo women, aged 36 and 60 years, developed CNS

toxicity after undergoing infraclavicular block withropivacaine during right forearm surgery.

The younger woman received a total dose of 40mL ofropivacaine 0.75% (300mg, 5.77 mg/kg), slowly injectedwith negative aspiration in 5mL increments. Verbalcommunication was maintained during the injection, andcomplete sensory and motor block were achieved. Twenty-four minutes after the injection, she reported nausea,dizziness, and numbness in the tongue. Under suspicion ofropivacaine-induced toxicity, thiopental sodium wasadministered for seizure prophylaxis, along withsupplemental oxygen via a face mask. She recovered over10 minutes, with no awareness of the episode. Shesubsequently underwent surgery while sedated withpropofol, with an uneventful postoperative recovery.

The older woman received a total dose of 40mL ofropivacaine 0.75% (300mg, 6.38 mg/kg), slowly injected in5mL increments with gentle aspirations between doses.Verbal communication was maintained during theprocedure, with successful complete sensory and motorblock. Twenty-eight minutes after the injection, sheexperienced disorientation and drowsiness, immediatelyfollowed by tonic-clonic seizure activity. Supplementaloxygen and propofol were administered, with resolution ofthe seizure. She regained consciousness 15 minutes later,with no sequelae or recall of the episode. She remainedclinically stable, with baseline mental status, andunderwent an uneventful surgery.

Author comment: "[W]e have presented 2 cases of localanesthetic toxicity induced by high doses (300 mg) ofropivacaine."Yang CW, et al. High dose ropivacaine-induced toxicity after infraclavicular block.Korean Journal of Anesthesiology 62: 96-97, No. 1, Jan 2012 - SouthKorea 803069432

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Reactions 21 Apr 2012 No. 13980114-9954/10/1398-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved