Seizure After Abdominal Surgery in an Infant Receiving a Standard-Dose Postoperative Epidural Bupivacaine Infusion

Abstract

We present the case of an otherwise healthy 12-month-old girl undergoing repair of a giant omphalocele, who experienced a postoperative seizure attributed to accumulation of bupivacaine from an epidural infusion. Whereas a standard dose was used, this patient experienced temporary liver dysfunction postoperatively, presumably from elevated intra-abdominal pressures, predisposing her to toxicity after a prolonged infusion. This case illustrates how the type of surgery can influence the margin of safety of routinely used neuraxial local anesthetic doses in infants and young children.

Local Anesthetic Systemic Toxicity

“…5,9,11,17,23,[32][33][34] The remaining cases resulted from neuraxial (13%: 4 of the 6 were epidural, 2 were described specifically as caudal injections), 16,20,26,29,30,38 paravertebral blocks (8.5%), 15,21,22,30 lower (8.5%) 6,7,13 and upper (8.5%) 6,31,36,39 extremity blocks, head and neck blocks (8.5%) (maxillary nerve, peribulbar), 14,19 topical, 28,35,37 transabdominis plane blocks, 8 and intravenous administration. 18 Seven cases (15%) involved continuous infusions of local anesthetic.…”

“…18 Seven cases (15%) involved continuous infusions of local anesthetic. 6,13,20,21,30 The block types associated with LAST are summarized in Figure 1.…”

“…There were 5 cases (11%) with onset of LAST ranging from 24 hours to 4 days, all involving continuous infusions of local anesthetic (interscalene, femoral/sciatic (2), epidural, paravertebral). 6,13,20,21 Presenting Features…”

Low-level laser therapy (LLLT) accelerates the sternomastoid muscle regeneration process after myonecrosis due to bupivacaine

“…Local anesthetics are generally used in clinical, medical and dental practices to reduce operative pain [1][2][3][4][5][6][7]and as co-adjuncts in postoperative analgesia [8][9][10][11][12][13].…”

GaAs laser therapy reestablishes the morphology of the NMJ and nAChRs after injury due to bupivacaine

“…These substances are widely used during medical and dental surgical procedures with the aim of achieving a safer and more comfortable procedure for patients [4][5][6][7][8][9][10], as well as the relief of postoperative pain. They are also used to treat chronic pain [11][12][13][14][15][16].…”