Reactions 900 - 4 May 2002

Ropivacaine

Neurological disorders: case reportThe use of perioperative ropivacaine in a 58-year-old man

undergoing radical prostatectomy was associated with thedevelopment of neurological disorders.

The man received 7ml of epidural ropivacaine 0.75% for T10level analgesia, after receiving a test dose of lidocaine/epinephrine [adrenaline]. His current medication wasbisoprolol. One hour after his first ropivacaine dose, acontinuous epidural infusion of ropivacaine 0.2% was startedat a rate of 5 ml/h. Ten hours later, the infusion rate wasincreased to 7 ml/h, and he received a single dose ofproparacetamol for slight pain. He received epidural analgesiafor a total of 72 hours.

The man experienced a violent, bilateral burning sensationand pain in his back and thighs 12 hours after ropivacaine wasdiscontinued. These sensations quickly spread to his legs andfeet, and the pain was exacerbated by lower extremitymovement, external pressure and his orthostatic position. Hereceived SC morphine and IV ketoprofen, and his symptomsresolved within 12 hours. He did not experience any furtherneurological disorders during 2 weeks’ follow-up.

Author comment: ‘During epidural anaesthesia, thetransmeningeal transfer of local anaesthetics may result inelevated intrathecal concentrations that probably contribute toTNM [transient neurological manifestations].’Al-Nasser B, et al. Transient neurological manifestations after epidural analgesiawith ropivacaine. Anaesthesia 57: 306-307, Mar 2002 - France 800899979

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Reactions 4 May 2002 No. 9000114-9954/10/0900-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved