Resuscitation Following a Bupivacaine Injection for a Cervical Paravertebral Block.

Abstract:

Background:Cardiac arrest related to nerve blockade using a local anaesthetic is a rare event. We report a case of bupivacaine severe cardiovascular toxicity following cervical paravertebral nerve block. Case presentation:A 44-year-old female was admitted to Republican Vilnius University Hospital, with symptoms of sustained severe pain in her neck that radiated to both arms. Multiple cervical intervertebral hernias with spinal stenosis were confirmed by magnetic resonance imaging. Following infiltration of the subcutaneous tissue with a 0.5 % bupivacaine solution, an 18-gauge spinal needle was used to perform the paravertebral block at the C6 level. Bupivacaine was injected in incremental doses to a total of 10 mL. Rapid loss of consciousness and cardiovascular collapse suggested a neuraxial injection of bupivacaine. Long-lasting cardiopulmonary resuscitation, including chest compressions, defibrillation attempts for refractory ventricular fibrillation, medications, mechanical ventilation, and intravenous lipid emulsion infusion, was successful. No severe adverse outcomes other than acute kidney injury and chest pain related to prolonged chest compressions were documented. Conclusions:This case report emphasizes the necessity of ensuring adequate safety precautions to avoid local anaesthetic systemic toxicity. Lipid emulsion preparations should be available in all hospital settings where local anaesthetics are used for regional anaesthesia or pain management.

journal_name

Open Med (Wars)

authors

Vosylius S,Uvarovas V,Svediene S,Satkauskas I

doi

10.1515/med-2019-0112

subject

Has Abstract

pub_date

2019-12-17 00:00:00

pages

953-958

issn

2391-5463

pii

med-2019-0112

journal_volume

14

pub_type

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