title: Successful resuscitation from bupivacaine-induced cardiovascular collapse with intravenous lipid emulsion following femoral nerve block in an emergency department.
abstract: We report a case of a 69-year-old woman with femoral neck fracture undergoing bupivacaine femoral nerve block for preoperative analgesia in an ED. Seizure and cardiovascular collapse developed immediately after instillation of local anaesthetic. Resuscitation including 20% lipid emulsion was successful in achieving normalization of haemodynamic parameters and ECG QRS duration. No adverse sequelae of lipid administration were observed. We recommend the immediate availability of lipid emulsion in emergency room settings where local anaesthetics are used.
authors.affiliation: Waikato Hospital, Hamilton, New Zealand. martyn.harvey@waikatodhb.health.nz
authors.forename: Martyn
authors.initials: M
authors.lastname: Harvey
authors.forename: Grant
authors.initials: G
authors.lastname: Cave
authors.forename: Giles
authors.initials: G
authors.lastname: Chanwai
authors.forename: Tonia
authors.initials: T
authors.lastname: Nicholson
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000009:adverse effects* / Q000097:blood; D002045:Bupivacaine / Q000009:adverse effects* / Q000097:blood; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005267:Femoral Nerve; D006323:Heart Arrest / Q000139:chemically induced / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods; D011300:Preoperative Care / Q000009:adverse effects; D012151:Resuscitation / Q000379:methods*
chemical_list: D000779:Anesthetics, Local; D005217:Fat Emulsions, Intravenous; D002045:Bupivacaine