Reactions 988 - 14 Feb 2004

SRopivacaine

Heart arrest in an elderly patient followingaccidental IV administration: case report

A 66-year-old man experienced heart arrest after accidentalIV injection of ropivacaine during posterior lumbar plexusblockade prior to hip arthroplasty.

The man, who had a history of coronary artery disease andmyocardial infarction, received treatment with hydroxyzine,sufentanil and lidocaine before undergoing anaesthesia with0.75% ropivacaine 25mL (187.5mg) injected over 2 minutes in5mL increments. Two minutes after receiving the full dose ofropivacaine he became unresponsive and experiencedgeneralised tonic-clonic seizures.

The man was treated with oxygen and diazepam. Hisseizures stopped within 1 minute and cardiac monitoringshowed asystole; he was intubated and CPR was started. Hereceived epinephrine [adrenaline] and, within 5 minutes,cardiac activity was restored. An ECG showed bradycardia (HR42 beats/min) and widening of his electrocardiographic wavecomplex; ECG findings returned to normal over the next10 minutes. One hour after the ropivacaine injection an arterialblood sample revealed metabolic acidosis (pH 7.1) andlaboratory investigations revealed a plasma lactate level of11.7 U/mL and a troponin I level of < 0.2U. There was noevidence of a lumbar plexus block. He was extubated an hourlater, at which time no sequelae were evident and an ECG wasnormal. Plasma ropivacaine concentrations at 55, 125 and420 minutes after ropivacaine injection were found to be 5.61,2.69 and 1.16 mg/L, respectively, and the estimatedropivacaine concentration at the time of heart arrest was17.44 µg/mL.

Author comment: "The severe adverse reaction observed,and the measured ropivacaine plasma concentrations, suggestthat at least a large part of 187.5-mg ropivacaine dose wasaccidentally intravascularly injected."Huet O, et al. Cardiac arrest after injection of ropivacaine for posterior lumbarplexus blockade. Anesthesiology 99: 1451-1453, No. 6, Dec 2003 -France 800970072

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Reactions 14 Feb 2004 No. 9880114-9954/10/0988-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved