Reactions 1409 - 7 Jul 2012

O SRopivacaine overdose

CNS toxicity following administration of aninadvertently large amount: case report

A 41-year-old man developed CNS toxicity followingadministration of an inadvertently large amount ofperineural ropivacaine in a transverse abdominis plane(TAP) block for postoperative pain.

The man, who had undergone a sigmoidostomy, wasadministered 20mL of ropivacaine 7.5 mg/mL at each of thefour points in a bilateral dual TAP block. He lostconsciousness 20 minutes later, and developedopisthotonos and generalised convulsions.

The man’s seizures resolved following treatment withsoya oil emulsion and diazepam. He regainedconsciousness, but had incoherent speech for half an hour.He was subsequently discharged in good condition,without any long-term neurologic sequelae.

Author comment: "It is generally agreed that the amountof perineural ropivacaine should not exceed 200mg. Aninterfascial deposition above this may result in potentiallyfatal adverse effects."Jensen K, et al. High volume nerve blocks and systemic toxicity of localanaesthetics. A case report. Regional Anesthesia and Pain Medicine 36 (Suppl. 2):E213, No. 5, Oct 2011 [abstract] - Denmark 803072465

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Reactions 7 Jul 2012 No. 14090114-9954/10/1409-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved