title: [Ropivacaine-induced late-onset systemic toxicity after transversus abdominis plane block under general anesthesia: successful reversal with 20% lipid emulsion].
abstract: We report a case of late-onset systemic toxicity due to ropivacaine over dose, and its successful reversal with 20% lipid emulsion (20% Intralipos). A 40-year-old woman, 40 kg, ASA-I, was scheduled for laparoscopy-assisted myomectomy of the uterus in which 40 ml of 0.375% ropivacaine was injected for bilateral US guided transversus abdominis plane block (TAPblock) under general anesthesia. Anesthesia proceeded uneventfully and she could go back to the ward 15 min later, but 3 hours after TAPblock, her blood pressure dropped to seventies and she became unresponsive. She also displayed clonic seizure/twitching of limbs. Immediately after diazepam 2 mg injection, clonic seizure disappeared and she could obey verbal commands. Within a few minutes clonic seizure was noted again, and she was hypotensive despite administration of vasopressors. A presumptive diagnosis of local anesthetic toxicity was made, and she received 100 ml bolus of 20% Intralipos. She regained consciousness with spontaneous return of blood pressure. She received a total of 230 ml 20% Intralipos, which was discontinued due to her rapid emergence with no further seizure episodes. This case suggests that early and sufficient use of lipid emulsion may lead to a good outcome. We recommend the immediate availability of lipid emulsion along with other emergency therapeutics at the ward after TAPblock.
authors.affiliation: Department of Anesthesiology, Kenporen Osaka Central Hospital, Osaka 530-0001.
authors.forename: Toshiko
authors.initials: T
authors.lastname: Sakai
authors.forename: Wataru
authors.initials: W
authors.lastname: Manabe
authors.forename: Taeko
authors.initials: T
authors.lastname: Kamitani
authors.forename: Eiko
authors.initials: E
authors.lastname: Takeyama
authors.forename: Sonoko
authors.initials: S
authors.lastname: Nakano
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation*; D000328:Adult; D000577:Amides / Q000633:toxicity*; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000633:toxicity*; D000931:Antidotes / Q000008:administration & dosage*; D062787:Drug Overdose; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery; D009407:Nerve Block / Q000009:adverse effects*; D000077212:Ropivacaine; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000931:Antidotes; D005217:Fat Emulsions, Intravenous; D000077212:Ropivacaine