title: Systemic ropivacaine toxicity from a peripheral nerve infusion in a medically complex patient.
abstract: This is a case of systemic ropivacaine toxicity from a sciatic nerve catheter. A 20-year-old patient after heart transplant with poor systemic perfusion on hemodialysis and multiple medications experienced local anesthetic systemic toxicity 72 hours after placement of a peripheral nerve catheter. The case demonstrates the potentially significant impact of medical comorbidities on system absorption of local anesthetics and reinforces that existing dose guidelines are not evidence based, and literature to guide local anesthetic bolus supplementation of continuous infusions is scant.
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, MS 9824, Seattle, WA 98105. Electronic address: eliot.grigg@seattlechildrens.org.
authors: Eliot
authors: E
authors: Grigg
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, MS 9824, Seattle, WA 98105. Electronic address: corrie.anderson@seattlechildrens.org.
authors: Corrie
authors: C
authors: Anderson
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, MS 9824, Seattle, WA 98105. Electronic address: martha.pankovich@seattlechildrens.org.
authors: Martha
authors: M
authors: Pankovich
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, MS 9824, Seattle, WA 98105. Electronic address: lizabeth.martin@seattlechildens.org.
authors: Lizabeth
authors: L
authors: Martin
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, MS 9824, Seattle, WA 98105. Electronic address: sean.flack@seattlechildrens.org.
authors: Sean
authors: S
authors: Flack
mesh_terms: D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods; D006435:Renal Dialysis; D000077212:Ropivacaine; D012584:Sciatic Nerve; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: Patient safety; Plasma concentration; Ropivacaine; Sciatic block; Toxicity