LipidRescue™ Resuscitation

While performing an ultrasound guided brachial plexus block (interscalene approach), our patient, a 19 year old 67 inch, 65 kg, ASA1 male,had received approximately 15 cc of 0.5% Ropivacaine injected incrementally, 5 cc, following negative aspiration. Despite visualizing what we thought was the location of the needle tip, local anesthetic spread was not seen during during the initial 5cc injection.The needle was repositioned and an additional two 5cc boulses of Ropivacaine were seen accumulating adjacent to the superior and middle trunks of the plexus. At the completion of the last bolus of Ropivacaine the patient began to repeatedly turn his head back and forth to the right as if glancing at the ultrasound machine.When asked where he was the patient replied, in a somewhat loud voice, but clearly articulated speech, that he was on a baseball field in W. Virginia. It was at this time that the author decided to abandon the procedure and bring him back to central Virginia. His systolic blood pressure was 190 and his heart rate was about 120, sinus. 100 cc of 20% intralipid was injected intravenously divided in three boluses within 1.5 minutes. Two mg of midazolam was also given during this interval.Within 2-3 minutes after beginning the intralipid administration the patient was back in a central Virginia outpatient surgery facility, his myoclonic neck movements had ceased and his vital signs were normal.There had been no LOC during this episode. The patient was observed for approximately one hour before proceeding to have an ORIF of his elbow performed under GETA. Approximately 5 hours after the incident the patient was discharged home.