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BJA Advance Access published online on October 19, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen297
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Convulsions after ropivacaine 300 mg for brachial plexus block

T. Satsumae1,*, M. Tanaka1, S. Saito2 and S. Inomata1

1 Department of Anaesthesiology and Critical Care Medicine, University of Tsukuba, Tsukuba City, Ibaraki 305-8575, Japan
2 Department of Anaesthesia and Critical Care Medicine, Tsukuba Gakuen General Hospital, Tsukuba City, Ibaraki, Japan

* Corresponding author. E-mail: tsuu{at}md.tsukuba.ac.jp

A healthy 18-yr-old male (weight 60 kg, height 167 cm), with a history of febrile convulsions in childhood, developed a grand mal convulsion 10 min after the second of two injections of ropivacaine 150 mg, both given incrementally 15 min apart (total 300 mg), for combined axillary/interscalene brachial plexus block. Treatment was with oxygen, lung ventilation, and i.v. midazolam, and the patient made a complete recovery. Arterial plasma ropivacaine concentration 2 min after the onset of convulsions was only 2.13 mg litre–1, suggesting that this patient was particularly susceptible to local anaesthetic toxicity. Whether sub-clinical EEG changes identified after operation were related to this sensitivity cannot be determined, but review illustrates wide variation in both the dose and the plasma concentration of local anaesthetics associated with systemic toxicity. The UK recommended dose of ropivacaine for brachial plexus block is 225–300 mg according to stature.

Keywords: anaesthetic techniques, regional, brachial plexus; anaesthetics local, ropivacaine; complications, convulsions; toxicity, local anaesthetics


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E-letters:

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Convulsion afte a toxic dose of ropivacaine
Yasir Al-Tamimi
British Journal of Anaesthesia, 2 Dec 2008 [Full text]
Intralipid
Muhammad Rahim Mansha Kayani
British Journal of Anaesthesia, 2 Dec 2008 [Full text]
Convulsions associated with ropivacaine 300mg for brachial plexus block
Sudhakar Marri, et al.
British Journal of Anaesthesia, 11 Dec 2008 [Full text]
Re: Intralipid
Tsuyoshi Satsumae, et al.
British Journal of Anaesthesia, 29 Dec 2008 [Full text]
Reply to Dr Marri
Tsuyoshi Satsumae, et al.
British Journal of Anaesthesia, 29 Dec 2008 [Full text]
Local Anesthetic Dosing Ranges May Be Misleading
James W. Heitz
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Central nervous system toxicity after two-stage brachial plexus block with 300 mg of ropivacaine
Simon J Parrington, et al.
British Journal of Anaesthesia, 25 Feb 2009 [Full text]
Re: Convulsions associated with low plasma level of local anaesthesics
Pierre Pasquier, et al.
British Journal of Anaesthesia, 18 Aug 2009 [Full text]

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