Convulsions Induced by Ropivacaine During Interscalene Brachial Plexus Block

Intravenous ropivacaine bolus is a reliable marker of intravascular injection in premedicated healthy volunteers

“…[8][9][10][11][12] One case did note CVS toxic effects with a dose of 2.5.mg·kg -1 used for sciatic nerve block with estimated total plasma levels at time of injection of 7.5 mg·L -1 . 12 In our study we noted no CVS effects at doses up to 1.2 mg·kg -1 .…”

A comparison of 1% ropivacaine with a mixture of 0.75% bupivacaine and 2% lignocaine for peribulbar anaesthesia

“…However, in this study no direct comparisons with ropivacaine or S(¹) bupivacaine were made, nor are there any reports in humans of this interesting effect. Irrespective of the wider safety margin compared with other local anaesthetics, there are reports 1999, 54, pages 1178-1182 ........................................................................................................................................................................................................................................... of toxic reactions with ropivacaine and care must still be taken with the administration of any highly concentrated local anaesthetic [18,19]. Minor morbidity is rarely reported in studies of local anaesthetics for ophthalmic anaesthesia, so comparisons with our data are not possible.…”

Successful defibrillation immediately after the intravascular injection of ropivacaine

“…Several case reports of central nervous system symptoms and cardiovascular symptoms after the unintentional intravascular injection of ropivacaine in relation to upper extremity blocks [8][9][10] and lower extremity blocks [5][6][7][11][12][13] have been published. Interestingly, five cases occurred during an attempted sciatic nerve block.…”

“…[1][2][3] However, it is a potent local anesthetic and ropivacaine-induced convulsions, cardiac dysrhythmias and even cardiac arrests have been described after unintentional intravascular injection during peripheral nerve blocks. [5][6][7][8][9][10][11][12] In a recent case report by Klein et al successful resuscitation after ropivacaine-induced ventricular fibrillation was described where resuscitation measures were successful without defibrillation. 13 Defibrillation was planned, but with the use of oxygen, propofol, intubation and chest compression, the circulation returned before the defibrillator was ready to use.…”