title: Methemoglobinemia after axillary block with bupivacaine and additional injection of lidocaine in the operative field.
abstract: Methemoglobinemia may occur after the administration of various drugs, including some local anesthetics. We report a patient with chronic renal failure and ischemic heart disease who developed clinically significant methemoglobinemia after an axillary block with bupivacaine and additional injection of lidocaine in the operative field. Although the two local anesthetics usually do not cause methemoglobinemia, we suspect that the displacement of lidocaine from protein binding by bupivacaine, in combination with metabolic acidosis and treatment with other oxidants, was the reason for the development of methemoglobinemia.
authors.affiliation: Department of Anaesthesiology, Eberhard-Karls-University Tuebingen, Germany.
authors.forename: T H
authors.initials: TH
authors.lastname: Schroeder
authors.forename: H J
authors.initials: HJ
authors.lastname: Dieterich
authors.forename: B
authors.initials: B
authors.lastname: Mühlbauer
mesh_terms: D000138:Acidosis / Q000150:complications; D000468:Alkalies / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D000931:Antidotes / Q000627:therapeutic use; D001365:Axilla / Q000294:innervation*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007676:Kidney Failure, Chronic / Q000150:complications; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects*; D008708:Methemoglobinemia / Q000139:chemically induced* / Q000188:drug therapy; D008751:Methylene Blue / Q000627:therapeutic use; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D009407:Nerve Block / Q000009:adverse effects*; D016877:Oxidants / Q000627:therapeutic use; D011485:Protein Binding / Q000187:drug effects; D017693:Sodium Bicarbonate / Q000627:therapeutic use
chemical_list: D000468:Alkalies; D000779:Anesthetics, Local; D000931:Antidotes; D016877:Oxidants; D017693:Sodium Bicarbonate; D008012:Lidocaine; D008751:Methylene Blue; D002045:Bupivacaine