Successful intralipid-emulsion treatment of local anesthetic systemic toxicity following ultrasound-guided brachial plexus block: case report
Received 1 March 2019
Accepted for publication 1 June 2019
Published 28 June 2019 Volume 2019:12 Pages 193—197
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Professor Ronald Prineas
Nguyen Trung Kien,1 Nguyen Truong Giang,2 Bui Van Manh,1 Nguyen Manh Cuong,3 Ngo Van Dinh,3 Dinh Cong Pho,4 Vu The Anh,3 Dao Thi Khanh,5 Luu Quang Thuy,6 Pham Van Dong7
1Center of Emergency, Critical Care Medicine, and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam; 2Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam; 3Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam; 4Faculty of Medicine, Vietnam Military Medical University, Hanoi, Vietnam; 5Department of Pharmacy, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam; 6Center of Anesthesia and Surgical Intensive Care, Vietduc University Hospital, Hanoi, Vietnam; 7Anesthesia and Pain Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
Background: Local anesthetic systemic toxicity (LAST) is a life-threatening complication that may follow application of LAs through various routes. Despite increasing usage of LA techniques in a large number of health-care settings, contemporary awareness of LAST and understanding of its management are inadequate.
Case presentation: We report two cases who suffered LAST following brachial plexus block for surgery on the upper extremity. The first patient received an ultrasound-guided supraclavicular block with 300 mg lidocaine (6 mg/kg) and 50 mg ropivacaine (1 mg/kg) in 25 mL without epinephrine, and the second patient received an ultrasound guided interscalene block with 200 mg lidocaine (4.5 mg/kg) and 45 mg ropivacaine (1 mg/kg) supplemented with epinephrine 1:200,000. Both patients presented with symptoms of central nervous and respiratory system depression, the first roughly 10 minutes after injection, and the second immediately after withdrawal of the needle. In both cases, thorough recovery was obtained using lipid-emulsion therapy.
Conclusion: The complication of LAST following ultrasound-guided brachial plexus block could be treated successfully applying the American Society of Regional Anesthesia and Pain Medicineprotocol of intravenous administration of lipid emulsion.
Keywords: local anesthetic system toxicity, lipid emulsion
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