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KMID : 1155520220170020228
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Anesthesia and Pain Medicine
2022 Volume.17 No. 2 p.228 ~ p.234
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Two cases of late-onset cardiovascular toxicities after a single injection of local anesthetics during supraclavicular brachial plexus block - A report of two cases -
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Kim Ji-Yeon
Park Beom-Il
Heo Min-Hee
Kim Kyoung-Woo
Lee Sang-Il
Kim Kyung-Tae
Choe Won-Joo
Park Jang-Su
Kim Jun-Hyun
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Abstract
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Background: Local anesthetics systemic toxicity (LAST) is a grave complication of regional anesthesia that usually occurs immediately after local anesthetics injection. Here, we report on rare late-onset toxicity cases after supraclavicular brachial plexus blocks.
Case: Two patients underwent surgery for radius fractures. We used lidocaine 100 mg and ropivacaine 150 mg for blocking and infused dexmedetomidine for intraoperative sedation. The 63-year-old male patient’s blood pressure dropped to 87/60 mmHg after 3 h 15 min after blocking. Ventricular fibrillation occurred 10 min later. After five defibrillations, electrocardiography showed ventricular tachycardia that was normalized through one cardioversion. The 54-year-old female patient’s heart rate decreased to 35 beats/min 2 h 30 min after blocking. Her vital signs returned to normal after administering atropine, ephedrine, epinephrine, and lipid emulsion.
Conclusions: Physicians should remember that LAST may occur long after local anesthetic injection and be aware of factors that may adversely affect the course of LAST.
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KEYWORD
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Adverse effects, Brachial plexus block, Lidocaine, Local anesthetic, Ropivacaine, Toxicity
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