title: Systemic local anaesthetic toxicity from continuous thoracic paravertebral block.
abstract: Continuous paravertebral block is commonly used for post-thoracotomy analgesia and compares favourably with other systemic and regional methods with regard to safety and efficacy. No major complications of continuous paravertebral block for post-thoracotomy analgesia have been reported previously. We report here a case of systemic local anaesthetic toxicity from continuous paravertebral block administration after thoracotomy and lobectomy leading to seizure, aspiration, and ultimately, death. Potential contributing factors in this case included small patient size, concomitant antifungal therapy, extensive surgical disruption of the pleurae, and inappropriate paravertebral bolus administration. Postoperative delirium was a diagnostic confounder. We discuss the potential causes and means of avoiding similar complications in the future.
authors.affiliation: Department of Anaesthesia, Theatres and Pain Medicine, Royal Infirmary Edinburgh, 51 LittleFrance Crescent, Edinburgh, EH16 4SU, UK. pfagenholz@partners.org
authors.forename: P J
authors.initials: PJ
authors.lastname: Fagenholz
authors.forename: G M R
authors.initials: GM
authors.lastname: Bowler
authors.forename: F M
authors.initials: FM
authors.lastname: Carnochan
authors.forename: W S
authors.initials: WS
authors.lastname: Walker
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D004334:Drug Administration Schedule; D017809:Fatal Outcome; D006801:Humans; D008172:Lung Diseases, Fungal / Q000601:surgery; D008297:Male; D008271:Mycetoma / Q000601:surgery; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D013904:Thoracic Vertebrae; D013908:Thoracotomy / Q000009:adverse effects
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine