Post Your Cases > Bupivacaine toxicity from fascia iliaca block

54yr female, fallen in street onto L hip sustained intertrochanteric fracture. In pain despite morphine and dropping SpO2 to 92% when left quietly. Fascia iliaca block performed (40ml 0.25% bupivacaine)2030hrs. after30ml injected, very slight pink stain to LA on aspirating once, not on further attempts at aspiration. Pt beginning to feel some benefit from block after 20mins but then felt "strange" & had paraesthesia in contralateral leg, followed by hypotension & bradycardia (HR40, slightly wide complexes, BP70/- initially)
Pt remained alert.
IV fluid bolus (approx 300ml Hartmans) & IV atropine(500mcg) had some effect whilst awaiting intralipid (ours in the ED was out of date!!!!) but delay only a couple of minutes.
With intralipid, BP & HR back to normal within 2mins.
I haven't looked at this for a while but am not aware of toxicity occurring with fascia iliaca block previously.
Our protocol is to do this blind (not U/S guided) with a nerve block needle. I have seen others obtain pink stained LA with this procedure, reposition needle & no complications. I don't know if U/S would really have made a significant difference with this technique & in this case. I shall be getting the probe out next time though.
October 20, 2011 | Unregistered CommenterDuncan Roche
Great case, Duncan. You might consider submitting as a letter to the editor to either an ER journal or RAPM. Good luck and thanks for posting.
Guy
October 26, 2011 | Registered Commenter[Guy Weinberg]