Convulsions Induced by Ropivacaine During Interscalene Brachial Plexus Block

A prospective analysis of interscalene brachial plexus blocks performed under general anesthesia

“…Perhaps the most important factor in safe and successful block performance lies in the experience and technical expertise of the anesthesiologist performing the block. 29,32 Lenters et al 31 reviewed their experience and the National American Society of Anesthesiology Closed Claims Project with use of interscalene brachial plexus blocks. They reported that more experienced anesthesiologists tended to have lower complication rates.…”

Ropivacaine-induced toxicity with overdose suspected after axillary brachial plexus block

“…Because repeated negative aspirations do not preclude the possibility of inadvertent intravascular injection [7][8][9][10], we used an intravenous catheter. Though a plastic catheter has a risk of collapse, we think such a catheter is better for moving the tips in the axillary sheath to avoid nerve injuries.…”

“…Toxic symptoms of ropivacaine, including inadvertent intravascular injections, present mainly as central nervous system (CNS) symptoms and less often as cardiovascular symptoms [1,2,7,14], although recent reports have stated that a large amount of ropivacaine may cause severe cardiovascular symptoms [9,13,15]. Additionally, caution is advised in patients in whom toxicity is suspected and who have no convulsions, if premedication such as midazolam has been administered, because this medication may have a protective anticonvulsant effect [15,16].…”

Comparison of ropivacaine 0.2% and 0.25% with lidocaine 0.5% for intravenous regional anesthesia

“…Therefore, potential adverse effects were not seen due to possible inadvertent intravascular injection of ropivacaine in the current study. In addition, the doses used in the current study (80 and 100 mg) were much lower than the doses in the reported two patients who had convulsions after inadvertent intravascular injection of 150 mg and 200 mg of ropivacaine [18,19]. Atanassoff et al [10] reported a lower incidence of CNS side effects in volunteers who received IVRA with 40 mL of ropivacaine 0.2% versus lidocaine.…”