Cardiac Arrest after Small Doses Ropivacaine: Local Anesthetic Systemic Toxicity in the Course of Continuous Femoral Nerve Blockade

The paper presents a case report of an episode of local anesthetic systemic toxicity (LAST) with cardiac arrest after continuous femoral nerve blockade. A 74-year-old patient burdened with hypertension and osteoarthritis underwent elective total knee replacement surgery. After surgery, a continuous...

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Bibliographic Details
Published in:International journal of environmental research and public health 2022-09, Vol.19 (19), p.12223
Main Authors: Gola, Wojciech, Bialka, Szymon, Zajac, Marek, Misiolek, Hanna
Format: Article
Language:English
Subjects:
Aged
Anesthetics, Local - adverse effects
Cardiac arrest
Cardiotoxicity
Case Report
Consciousness
Elastomers
Emulsions - therapeutic use
Femur
Heart
Heart Arrest - chemically induced
Hemodynamics
Humans
Hypertension
Lipids
Local anesthesia
Narcotics
Nerve Block - adverse effects
Nerve Block - methods
Nervous system
Neurological diseases
Orthopedics
Osteoarthritis
Patients
Regional anesthesia
Ropivacaine
Ropivacaine - adverse effects
Seizures
Surgery
Toxicity
Ultrasonic imaging
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Summary:The paper presents a case report of an episode of local anesthetic systemic toxicity (LAST) with cardiac arrest after continuous femoral nerve blockade. A 74-year-old patient burdened with hypertension and osteoarthritis underwent elective total knee replacement surgery. After surgery, a continuous femoral nerve blockade was performed and an infusion of a local anesthetic (LA) was started using an elastomeric pump. Five hours after surgery, the patient had an episode of generalized seizures followed by cardiac arrest. After resuscitation, spontaneous circulation was restored. In the treatment, 20% lipid emulsion was used. On day two of the ICU stay, the patient was fully cardiovascularly and respiratorily stable without neurological deficits and was discharged to the orthopedic department to continue treatment. Systemic toxicity of LA is a serious and potentially fatal complication of the use of LA in clinical practice. It should be noted that in nearly 40% of patients, LAST deviates from the classic and typical course and may have an atypical manifestation, and the first symptoms may appear with a long delay, especially when continuous blockades are used. Therefore, the proper supervision of the patient and the developed procedure in the event of LAST is undoubtedly important here.
ISSN:1660-4601
1661-7827
1660-4601
DOI:10.3390/ijerph191912223