Reactions 1411 - 21 Jul 2012

★ SRopivacaine

Temporary quadriplegia (first report) due tomisplaced catheter in an elderly patient: casereport

A 76-year-old man developed temporary quadriplegiaduring treatment with ropivacaine due to a misplacedcatheter.

The American Society of Anesthesiologists (ASA) physicalstatus 2 man, who had a history of hypertension, asbestosexposure and radical left nephrectomy, underwent aculminectomy for tumour ablation under generalanaesthesia. A thoracic paravertebral block catheter wasinserted at the end of his surgery. After sodium chloridewas injected through the catheter, negative aspiration wasconfirmed. A continuous infusion of 0.2% ropivacaine(2 mg/mL) was started with a flow of 7 mL/hr through thecatheter. Ninety minutes later, he reported paralysis in allfour limbs. He had received 21mg of ropivacaine (10.5mL).

Neurologic examination confirmed paralysis of his lowerand upper intercostal muscles and complete immobility ofhis arms and legs. He also had loss of cold sensation up toC7. His chest X-ray was consistent with intrathecal catheterlocalisation, and his CT scan was confirmatory. He wasdiagnosed with a misplaced catheter, and his localanaesthetic perfusion was discontinued immediately.Four hours after catheter removal, his quadriplegiaresolved completely. He was discharged with noneurologic sequelae.

Author comment: "After the start of the continuousinfusion of ropivacaine 0.2%, quadriplegia developed but itresolved after discontinuation of the ropivacaine 0.2%infusion."Calenda E, et al. Temporary quadriplegia following continuous thoracicparavertebral block. Journal of Clinical Anesthesia 24: 227-230, No. 3, May 2012.Available from: URL: http://dx.doi.org/10.1016/j.jclinane.2011.07.017 -France 803073669

» Editorial comment: A search of AdisBase, Medline,Embase and The WHO ADR database did not reveal anyprevious case reports of quadriplegia associated withropivacaine.

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Reactions 21 Jul 2012 No. 14110114-9954/10/1411-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved