Central nervous system toxicity following the administration of levobupivacaine for lumbar plexus block: A report of two cases

Breslin, Dara S.; Martin, Gavin; MacLeod, David B.; D’Ercole, Francine; Grant, Stuart A.

doi:10.1053/rapm.2003.50127

Cited by 41 publications

(35 citation statements)

References 22 publications

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“….............................................................................................................................................................................................................. We did not measure plasma levobupivacaine concentrations, so we are unable to comment on the effect of Intralipid on serum concentrations of local anaesthetic. Previous authors have highlighted the variability in plasma concentration required to cause toxicity following the administration of other local anaesthetics [6,11]. This is the first report of the use of lipid emulsion in a peri-arrest situation.…”

Section: Discussionmentioning

confidence: 78%

Levobupivacaine‐induced seizures and cardiovascular collapse treated with Intralipid^®

McCahon²,

et al. 2007

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Summary Lipid emulsion has been used in the successful treatment of local anaesthetic‐induced cardiovascular collapse in animals and in two cases of cardiac arrest in humans. Previous reports of levobupivacaine toxicity in humans have been characterised by neurological signs and symptoms, without serious cardiovascular events. We present a case in which presumed intravenous injection of levobupivacaine led to neurological and cardiovascular consequences. This was treated successfully by resuscitation that included intravenous Intralipid® infusion.

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Section: Discussionmentioning

confidence: 78%

Levobupivacaine‐induced seizures and cardiovascular collapse treated with Intralipid^®

McCahon²,

et al. 2007

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“…During closure of the wound, the incisional sites were infi ltrated with bupivacaine 20 ml, 0.25%, 2.5 mg/ml, with epinephrine 5 μg/ml, in all patients (14). Residual neuromuscular blockade was antagonized with a mixture of neostigmine and atropine (15). In the postoperative period, patients were assessed on awakening and then at 1, aft er 6 and aft er 12 hours by a trained observer.…”

Section: Patients and Proceduresmentioning

confidence: 99%

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

Ivanov

Veljkova

2011

JHSCI

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Introduction: Intraperitoneal administration of local anesthetic in combination with an opioid, for the relief of postoperative pain, has already been reported after laparoscopic cholecystectomy. This study aimed to assess the analgesic effect of the intraperitoneal administration of bupivacaine and morphine, in patients undergoing laparoscopic cholecystectomy. Methods: 90 patients (30 patients in each group) were included in a double blind, randomized manner. At the end of laparoscopic cholecystectomy, the patients were intraperitoneally treated with 30 ml of: physiological saline (Group 1) or 0.25% bupivacaine (Group 2) or 0.25% bupivacaine + 2 mg morphine (Group 3). Patient's postoperative pain was evaluated using a visual analogue scale and a verbal rating score. The postoperative analgesic requirement was assessed by the total dose of Ketorolak, administered by intravenous or intramuscular route. Pain, vital signs, supplemental analgesics consumption and side effects were recorded for all patients for 12h. Results: There were no difference between the three groups, regarding pain scores (et rest and coughing) during the study, except in the fi rst 6 h, when scores were lower for patients receiving intraperitoneal bipuvacaine + morphine (p<0.05). Conclusions:In the patients undergoing laparoscopic cholecystectomy, the intraperitoneal administration of bupivacaine + morphine, reduced the analgesic requirements during the fi rst 6 postoperative hours compared with the control groups. The combination of intraperitoneal bupivacaine 0.25% and morphine was more effective for treatment of pain after laparoscopic cholecystectomy.

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“…However, this does not negate the need for additional precautions as both agents can still cause significant LAST. 9,13,26,34 Early detection of vascular puncture and intravascular injection…”

Section: Use Of Safer Lasmentioning

confidence: 99%

“…En revanche, cela ne nous dispense pas de prendre des précautions supplémentaires, étant donné que ces deux agents peuvent tout de même provoquer une importante TSAL. 9,13,26,34 Détection précoce de la ponction vasculaire et de l'injection intravasculaire…”

Section: Utilisation D'al Plus Sécuritairesunclassified

Local anesthetic systemic toxicity: Continuing Professional Development

El‐Boghdadly

Chin

2016

Can J Anesth/J Can Anesth

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Purpose Regional anesthesia is enjoying a renaissance due in part to the advent of ultrasound guidance and the development of new techniques such as tissue plane blocks and local infiltration analgesia. The purpose of this Continuing Professional Development module is to provide practitioners with an understanding of the current state of knowledge surrounding local anesthetic systemic toxicity (LAST) in order to help them prevent and manage this complication more effectively. Principal findings The causes of LAST are multifactorial, but recognized risks include patient factors, drug doses, pharmacokinetics, and choice of regional anesthetic technique. Local anesthetic systemic toxicity produces a biphasic course of clinical events that generally begin with central nervous system excitation followed by inhibition. At the same time, it causes cardiovascular compromise due to dysrhythmias, myocardial depression, and reduced systemic vascular resistance. Clinical presentation can be highly variable, however, and atypical presentations are not uncommon. Local anesthetic systemic toxicity is prevented by careful choice and dosing of drugs, aspiration before injection, dose fractionation, use of intravascular markers and ultrasound guidance. The management of LAST includes adequate oxygenation and ventilation, seizure termination, maintenance of circulation, and intravenous lipid emulsion therapy.Conclusions Local anesthetic systemic toxicity is a potentially lethal condition with protean manifestations, and anesthesiologists must understand its risks, prevention, and safe management.

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Central nervous system toxicity following the administration of levobupivacaine for lumbar plexus block: A report of two cases

Cited by 41 publications

References 22 publications

Levobupivacaine‐induced seizures and cardiovascular collapse treated with Intralipid^®

Levobupivacaine‐induced seizures and cardiovascular collapse treated with Intralipid^®

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

Local anesthetic systemic toxicity: Continuing Professional Development

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Central nervous system toxicity following the administration of levobupivacaine for lumbar plexus block: A report of two cases

Cited by 41 publications

References 22 publications

Levobupivacaine‐induced seizures and cardiovascular collapse treated with Intralipid®

Levobupivacaine‐induced seizures and cardiovascular collapse treated with Intralipid®

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

Local anesthetic systemic toxicity: Continuing Professional Development

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Product

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Levobupivacaine‐induced seizures and cardiovascular collapse treated with Intralipid^®

Levobupivacaine‐induced seizures and cardiovascular collapse treated with Intralipid^®