<p>A Rare Case of Euphoria Caused by Lidocaine After an Erector Spinae Plane Block: A Case Report</p>

Abstract

Lidocaine is a cost-effective drug that is widely used for local and regional anesthesia. However, central nervous system (CNS) toxicity can occur when lidocaine is administered above the maximum recommended dose (approximately 4.5 mg/kg) or if lidocaine is injected intravascularly rather than administered locally. Systemic toxicity by lidocaine has been reported in several studies. However, psychotic reactions due to lidocaine have been rarely reported; furthermore, reports of lidocaine-related euphoria are very rare. We report a very rare case of euphoria caused by CNS toxicity that occurred during the local administration of lidocaine at the therapeutic dose. Therefore, anesthesiologists should be aware of the severe side effects of local anesthetics despite administering the appropriate dosage at the appropriate location. Future studies should investigate pharmacokinetics to determine the safety profile of local anesthetics.

Analgesia efficacy of erector spinae plane block in laparoscopic abdominal surgeries: a systemic review and meta-analysis

“…Like other interfascial plane blocks, ESPB are regarded as ‘volume’ blocks 44 and local anaesthetic agents are injected in large volumes into a highly vascularised plane 45 hence resulting in a significant risk of LAST. Studies 46 have suggested that ESPB may result in LAST even when anaesthetic agents not administered at their maximum doses. Possible contributing factors include age, comorbids, and concurrent drug use 47 .…”

Comparison of plasma levobupivacaine concentrations with and without epinephrine following erector spinae plane block for breast cancer surgery: a randomized controlled trial

“…Yawata et al [ 19 ] performed bilateral lumbar ESP blocks at the L4 level by using 2.6 mg/kg of levobupivacaine, resulting in convulsions in a patient. Another study by Lee et al [ 20 ] reported that a unilateral ESP block at the T6 level by using 1.3 mg/kg of lidocaine caused symptoms of a psychotic reaction. These studies suggest that an ESP block may produce LAST even if local anesthetics below the maximum recommended dose are administered.…”