Reactions 1005 - 12 Jun 2004

★ SRopivacaine/sufentanil

First report of Guillain-Barre syndrome in apregnant woman: case report

A 27-year-old pregnant woman with Guillain-Barresyndrome experienced worsening neurological symptomsafter epidural analgesia with ropivacaine and sufentanil.

The woman, who had been diagnosed with Guillain-Barresyndrome in her 36th week of pregnancy and had been treatedwith IV immunoglobulin therapy, went into labour at41 weeks’ gestation and received epidural analgesia; an initialinjection of 0.2% ropivacaine 10mL and sufentanil 10µg wasadministered, followed by additional doses of 0.2%ropivacaine 15mL and sufentanil 6µg administered over3 hours via a patient-controlled epidural analgesia device.Following an uneventful delivery 4 hours later, she had bothsensory and motor block. However, she did not fully recoverfrom the motor block and, 12 hours later, was unable to walkdue to increased weakness of her lower extremities andexperienced increased facial and upper extremity weakness.On examination, nerve conduction velocities and distallatencies had decreased since epidural administration.

The woman received high-dose IV immunoglobulin therapyand experienced mild symptom improvement. A rehabilitationprogram was started but, after 4 months, she continued toexperience gait disturbance.

Author comment: "It is possible that a toxic effect ofanesthetics on the nervous system may partly explain theimmediate postpartum clinical worsening of our patient."Wiertlewski S, et al. Worsening of neurologic symptoms after epidural anesthesiafor labor in a Guillain-Barre patient. Anesthesia and Analgesia 98: 825-827, No. 3,Mar 2004 - France 800974751

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of Guillain-Barre syndromeassociated with ropivacaine or sufentanil. The WHO AdverseDrug Reactions database contained one report of neuritis and sixof neuropathy associated with ropivacaine, and two reports ofneuropathy associated with sufentanil.

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Reactions 12 Jun 2004 No. 10050114-9954/10/1005-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved