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Anesth Analg 2005;101:924
© 2005 International Anesthesia Research Society

LETTER TO THE EDITOR

Seizures After a Bier Block with Clonidine and Lidocaine: Is Clonidine Really the Culprit?

Shihab U. Ahmed, MBBS, MPH, Ricardo Vallejo, MD, PhD, and E. Daniela Hord, MD

Pain Management Center; Lowell General Hospital; Lowell, MA; sahmed{at}lowellgeneral.org (Ahmed) Massachusetts General Hospital Pain Center; Department of Anesthesia and Critical Care; Massachusetts General Hospital and Harvard Medical School; Boston, MA (Vallejo, Hord)

In Response:

We appreciate the comments of Datta et al. regarding our recent case report of seizures after a Bier block with clonidine and lidocaine (1). They appropriately emphasize the small dose of clonidine used in this case and longer duration of tourniquet inflation, both of which should led to a lower plasma concentration of the clonidine. We agree with the authors that the likely cause of seizure in this case is multifactorial, as we pointed out in the report, including the possible role of nortriptyline, potentially lowering the seizure threshold. It is our hope that with wider uses of clonidine by regional anesthesiologists and pain practitioners, more human data will be available to allow optimizing the dose when used in combination with local anesthetics.

Reference

  1. Ahmed SU, Vallejo R, Hord ED. Seizures after a Bier block with clonidine and lidocaine. Anesth Analg 2004;99:593–4.[Abstract/Free Full Text]




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press