title: Acute toxicity of local anesthetic ropivacaine and mepivacaine during a combined lumbar plexus and sciatic block for hip surgery.
abstract: Hip fracture is a common pathology in elderly patients. Intercurrent diseases, mainly cardiac and respiratory, often result in significant morbidity and mortality. Anesthesia for hip fracture can be provided by general or regional techniques. The combination of a lumbar plexus and posterior sciatic nerve block represents an alternative to neuraxial technique of anaesthesia such as spinal anesthesia (4, 6). We report a case of acute toxicity resulting in the injection of local anesthetics Ropivacaine and Mepivacaine in elderly patient. An elderly woman was scheduled for surgical repair of a fractured femur neck by dynamic hip screw synthesis. Anesthesia was realized by peripheral nerve bi-block (lumbar plexus and posterior sciatic block) (7). The patient experienced seizures and dysrhythmias twenty minutes after block completion and injection of the anesthetic solution [Ropivacaine 0.75%, administered for lumbar plexus block performed via the posterior approach (WINNIE) and Mepivacaine 1.5%, administered for posterior sciatic nerve block (LABAT)]. Cardiopulmonary resuscitation was successful. All signs of toxicity disappeared after injection of midazolam and atropine, intubation and 100% oxygen ventilation. We decided to proceed with surgery. The postoperative course was uncomplicated and made a full recovery.
authors.affiliation: Department of Anesthesiology, University of St-Luc Hospital, Brussels, Belgium. christianmullanu@hotmail.com
authors.forename: Ch
authors.initials: Ch
authors.lastname: Mullanu
authors.forename: F
authors.initials: F
authors.lastname: Gaillat
authors.forename: F
authors.initials: F
authors.lastname: Scemama
authors.forename: S
authors.initials: S
authors.lastname: Thibault
authors.forename: P
authors.initials: P
authors.lastname: Lavand'homme
authors.forename: J P
authors.initials: JP
authors.lastname: Auffray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006801:Humans; D008160:Lumbosacral Plexus; D008619:Mepivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D009407:Nerve Block / Q000009:adverse effects*; D000077212:Ropivacaine; D012584:Sciatic Nerve; D012640:Seizures / Q000139:chemically induced
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008619:Mepivacaine