Reactions 1421 - 29 Sep 2012

SRopivacaine

Seizures: case reportA 59-year-old patient [sex not stated] developed seizures

following locoregional ropivacaine administration foringuinal hernia repair.

The patient, who had chronic liver disease and Child’sgrade C cirrhosis, received 30mL ropivacaine 7.5%injection (3 mL/kg) in an ultrasound-guided transverseabdominis plane block (TAPB) prior to surgery.Fifteen minutes later, the patient experienced seizures.

Intralipid solution was injected immediately, andproduced a rapid neurological improvement. At the time ofthe seizures, the plasma ropivacaine concentration was2.8 µg/mL. Local anaesthesia intoxication was confirmed.Surgery was possible 30 minutes after the seizures. Thepatient was transferred to the ICU [outcome not stated].

Author comment: "As large doses of [local anaesthetics]are injected in TAPB, systemic toxicity of the [localanaesthetic], as a result of absorption into the circulation,should always be considered. A TAPB can potentially causesystemic toxicity of [local anaesthetics] . . . our case reportsuggests that we should reduce [local anaesthetic] dose in thecase of specific medical conditions such as Child’s Ccirrhosis".Landy C, et al. Seizures associated with local anaesthetic intoxication. BritishJournal of Anaesthesia 109: 463-464, No. 3, Sep 2012. Available from: URL:http://dx.doi.org/10.1093/bja/aes286 - France 803077855

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Reactions 29 Sep 2012 No. 14210114-9954/10/1421-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved