Two fatal and four surviving cases after accidental infusion of ropivacaine

Purpose In this paper, we describe six cases, where patients were falsely treated with pre-filled ropivacaine solution instead of medical saline solution for postoperative settings. Two of the patients died because of fatal concentrations of ropivacaine in blood, four survived with no further physic...

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Bibliographic Details
Published in:Forensic toxicology 2021-07, Vol.39 (2), p.506-512
Main Authors: Winkler, Michaela, Alt, Andreas, Dietzsch, Susann, Kunz, Sebastian N.
Format: Article
Language:English
Subjects:
Case Report
Forensic Medicine
Forensic Science
Medical Law
Medicinal Chemistry
Medicine
Medicine & Public Health
Pharmacology/Toxicology
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Summary:Purpose In this paper, we describe six cases, where patients were falsely treated with pre-filled ropivacaine solution instead of medical saline solution for postoperative settings. Two of the patients died because of fatal concentrations of ropivacaine in blood, four survived with no further physical injury, and two of them showed typical intoxication symptoms. The collected blood and urine samples of the deceased, as well as the surviving patients, were analyzed in laboratory routine screening. Methods Ropivacaine and its main metabolite 3-OH-ropivacaine were analyzed by gas chromatography–mass spectrometry. Results All of the six cases showed positive blood results of ropivacaine. Due to the poorly secured sample material of the survived patients at hospital, the quantitative examination of 3-OH-ropivacaine could not be carried out. In one fatal case, there were ropivacaine and 3-OH-ropivacaine traceable in urine. In all cases, metamizole was found in blood and traces of piritramide in urine. The amount of metamizole was within the upper limits of therapeutical treatment values. Patients with lower blood concentrations of ropivacaine showed more physical symptoms as compared to those with higher concentrations of active substances. Conclusions In the context of symptom development and intoxication, the speed of injection was a very important factor to cause fatal ropivacaine cases. To our knowledge, these are the first reported cases of fatal intoxication with ropivacaine.
ISSN:1860-8965
1860-8973
DOI:10.1007/s11419-021-00574-x