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REGIONAL ANESTHESIA

Grand Mal Convulsion After an Accidental Intravenous Injection of Ropivacaine

Mira Dernedde, MD^*, Danièlle Furlan, MD^*, René Verbesselt, MD PhD, Elisabeth Gepts, MD^*, and Jean G. Boogaerts, MD PhD^*

*Department of Anesthesiology, University Hospital Center, Charleroi and the Department of Clinical Pharmacology, University Hospital Center, Leuven, Belgium

Address correspondence to Dr. Mira Dernedde, Department of Anesthesiology, University Hospital Center, 92 boulevard P. Janson, 6000 Charleroi, Belgium. Address email to mira.dernedde{at}chu-charleroi.be

A 36-yr old, ASA physical status I patient scheduled for hip arthroplasty under regional anesthesia received at the end of surgery an IV injection of approximately 200 mL of a 0.15% ropivacaine solution (300 mg = 4.6 mg/kg) in approximately 5 min. The bag prepared for postopera- tive epidural infusion was accidentally connected to a peripheral IV line. The patient developed grand mal convulsions, hypotension, and respiratory arrest. No arrhythmias were observed. Twenty minutes after the event, the arterial plasma concentration of ropivacaine was 3.10 µg/mL. Using a pharmacokinetic model, the peak plasma concentration at the time of the accidental administration was estimated at 17.04 µg/mL. The patient recovered uneventfully.

IMPLICATIONS: An accidental IV injection of approximately 300 mg of ropivacaine was followed by seizures without any arrhythmia. The patient recovered uneventfully.

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