A Case of Local Anesthetics-Induced Toxicity after Transversus Abdominis Plane Block

Ideno, Satoshi; Nakajima, Yoshiki; Watanabe, Kaoru

doi:10.2199/jjsca.33.092

Cited by 2 publications

(7 citation statements)

References 11 publications

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“…Maternal age ranged from 16 to 40 years. Seven women were full-term (≥ 37 weeks’ gestation) [ 33 – 38 , 40 ], four were preterm (< 37 weeks’ gestation) [ 23 , 29 , 38 , 41 ] and eleven were of unknown gestational age when LAST occurred [ 23 , 29 , 39 , 42 – 44 ]. Six women had pre-existing or pregnancy-induced medical conditions [ 34 , 35 , 37 , 38 , 41 ]; three were healthy [ 29 ]; and medical conditions were not reported for the rest.…”

Section: Resultsmentioning

confidence: 99%

“…Of the causes reported ( n = 10), the most frequently cited was drug overdose ( n = 3) [ 23 , 29 , 38 ], Although not reported by the original authors, we identified one more case of an overdose in which the patient received a local anaesthetic dose exceeding the maximum recommended dose for an adult [ 40 ]. Both intravascular migration of the epidural catheter [ 29 , 34 , 37 ], and wrong route drug errors [infusions containing bupivacaine were accidentally connected to peripheral venous lines] ( n = 3) [ 29 , 42 – 44 ], were mentioned in 3 reports each, followed by unintentional partial intramuscular injections of a local anaesthetic ( n = 1) [ 38 ].…”

Section: Resultsmentioning

confidence: 99%

“…Both intravascular migration of the epidural catheter [ 29 , 34 , 37 ], and wrong route drug errors [infusions containing bupivacaine were accidentally connected to peripheral venous lines] ( n = 3) [ 29 , 42 – 44 ], were mentioned in 3 reports each, followed by unintentional partial intramuscular injections of a local anaesthetic ( n = 1) [ 38 ]. In most cases, assessing drug overdosage was impossible because of the lack of information about the patient’s weight, the use of epinephrine or adrenaline (which reduces systemic absorption and maximum plasma concentrations of a local anaesthetic) [ 23 , 29 , 35 – 38 , 40 , 42 , 43 ] or dose of local anaesthetic used [ 41 ].…”

Section: Resultsmentioning

confidence: 99%

“…Perioral tingling tongue paraesthesia Case 3. Metallic taste Ideno et al 2013 [ 40 ] Age: 20 Gestation: 37 wks 165 cm, 49 kg (prepregnancy 42 kg) TAP block after CS with spinal anaesthesia TAP: lidocaine 200 mg Ropivacaine 150 mg CS: hyperbaric bupivacaine 10 mg Dizziness Dysarthria, Numbness of lips, Visual disturbance None NR Not used N/A Colloid infusion Mother: Symptoms resolved Baby: N/A Wada et al 2011 [ 41 ] Age: 28 Gestation: 32 wks TAP block after CS Ropivacaine (dose: NR) Restlessness Seizure NR NR Not used N/A Magnesium sulphate diazepam Mother: Symptoms resolved Baby: N/A Smetzer et al 2010 [ 42 ] Age: 16 N/A Intravascular infusion of Bupivacaine Seizure Respiratory distress Apnoea Cardiac arrest Wrong route drug error Not used N/A ACLS Mother: Death Baby born healthy by CS Sud & Szawarski 2018 [ 43 ] Age: 30 N/A Intravascular infusion of bupivacaine 150 mg Dizziness, Loss of consciousness, Seizure Ventricular fibrillation Cardiac arrest Wrong route drug error Not used N/A ACLS Mother: Death Baby: N/A ...…”

Section: Methods and Analysismentioning

confidence: 99%

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Intravenous lipid emulsion for local anaesthetic systemic toxicity in pregnant women: a scoping review

Tsuji,

Nii,

Furuta

et al. 2024

BMC Pregnancy Childbirth

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Background Local anaesthetic systemic toxicity (LAST) is a rare but life-threatening complication that can occur after local anaesthetic administration. Various clinical guidelines recommend an intravenous lipid emulsion as a treatment for local anaesthetic–induced cardiac arrest. However, its therapeutic application in pregnant patients has not yet been established. This scoping review aims to systematically identify and map the evidence on the efficacy and safety of intravenous lipid emulsion for treating LAST during pregnancy. Method We searched electronic databases (Medline, Embase and Cochrane Central Register Controlled Trials) and a clinical registry (lipidrescue.org) from inception to Sep 30, 2022. No restriction was placed on the year of publication or the language. We included any study design containing primary data on obstetric patients with signs and symptoms of LAST. Results After eliminating duplicates, we screened 8,370 titles and abstracts, retrieving 41 full-text articles. We identified 22 women who developed LAST during pregnancy and childbirth, all presented as case reports or series. The most frequent causes of LAST were drug overdose and intravascular migration of the epidural catheter followed by wrong-route drug errors (i.e. intravenous anaesthetic administration). Of the 15 women who received lipid emulsions, all survived and none sustained lasting neurological or cardiovascular damage related to LAST. No adverse events or side effects following intravenous lipid emulsion administration were reported in mothers or neonates. Five of the seven women who did not receive lipid emulsions survived; however, the other two died. Conclusion Studies on the efficacy and safety of lipids in pregnancy are scarce. Further studies with appropriate comparison groups are needed to provide more robust evidence. It will also be necessary to accumulate data—including adverse events—to enable clinicians to conduct risk–benefit analyses of lipids and to facilitate evidence-based decision-making for clinical practice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methods and Analysismentioning

confidence: 99%

See 2 more Smart Citations

Intravenous lipid emulsion for local anaesthetic systemic toxicity in pregnant women: a scoping review

Tsuji,

Nii,

Furuta

et al. 2024

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…8 TAP block can induce local anaesthetics-induced toxicity, especially when administered after surgery. 9 Neurotoxicity was experienced, despite using modest doses of local anaesthetic, in awake pregnant woman undergoing TAP block during caesarean section. 10 To our knowledge, no cases of local toxicity were reported in literature.…”

Section: Discussionmentioning

confidence: 99%

Clinical implications of transversus abdominis plane block (TAP-block) for robot assisted laparoscopic radical prostatectomy: A single-institute analysis

et al. 2020

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Introduction: The aim of this study was to evaluate the role of TAP block in improvement of anesthesiological management and perioperative surgical outcomes of robot-assisted laparoscopic radical prostatectomy (RALP). Methods: We consecutive enrolled 93 patients with prostate cancer whose underwent RALP at our department from January 2019 to December 2019. Group A included 45 patients who received bilateral TAP block, and Group B included 48 patients who did not received TAP block. TAP blocks were always performed by a single anesthesia team. An elastomeric pump device was used in all patients for post-operative pain management. TAP block was performed according to Rafi’s technique, with Ropivacaine 0.375% and dexamethasone 4 mg. Mean values with standard deviations (±SD) were computed and reported for all items. Statistical significance was achieved if p-value was ⩽0.05 (two-sides). Results: The two groups showed no difference in the most important demographics and baseline characteristics ( p > 0.05). Group A showed a significant longer time of anaesthesia. Moreover, Ketorolac doses (started dose plus continuous post-operative infusion via elastomeric pump) used in Group A were significantly lower than Group B. Despite this, Group B showed statistical significant higher value of NRS PACU and at 12, 24, 48, 72 h than Group A but not at 96 h. Rescue analgesic medication use was significantly higher in the Group B than Group A. Moreover, patency of the intestinal tract and time to ambulation was significantly lower in the Group A. Discussion: The use of TAP block during a RALP is a safe procedure that can be applied more appropriately to achieve better pain control. A multimodal protocol that includes locoregional anesthesia, reduction of intra and postoperative use of strong opiates, correct placing of the patient and the use of low pneumoperitoneum pressures should be implemented in order to reach a faster and better post-operative full recovery of patients whose underwent RALP.

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A Case of Local Anesthetics-Induced Toxicity after Transversus Abdominis Plane Block

Cited by 2 publications

References 11 publications

Intravenous lipid emulsion for local anaesthetic systemic toxicity in pregnant women: a scoping review

Intravenous lipid emulsion for local anaesthetic systemic toxicity in pregnant women: a scoping review

Clinical implications of transversus abdominis plane block (TAP-block) for robot assisted laparoscopic radical prostatectomy: A single-institute analysis

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