Post Your Cases > Presumed bupivicaine toxicity from epidural top-up
A healthy 40 year old 62kg lady had a labour epidural sited. No problems were noted during insertion. 4 doses of 20ml 0.1% bupivicaine mix (20mg of bupivicaine with 4mcg of fentanyl) were given 2 to 3 hours apart. 37 minutes after the 4th dose she experienced pain. Bupivicaine 10ml of 0.25% (25mg) was given epidurally. Her heart rate rose immediately from 80 to 100. After 30 minutes her midwife called an Anaesthetist to review because she was complaining of intense dizziness. She described her heart as racing (pulse now 120) and on direct questioning about numbness or tingling anywhere described tingling of her nose and cheeks. Her blood pressure was unchanged at 120/80. She had no other symptoms. 100ml of intralipid was given as an IV bolus over 2 to 3 minutes. Her dizziness immediately subsided, she opened her eyes and said she felt much better. Her blood pressure transiently rose to 180/100 after the bolus. Her heart rate settled to 100.
No further drugs were given epidurally. She had a normal delivery of a healthy baby.
37 minutes after the 4th dose she experienced pain. Bupivicaine 10ml of 0.25% (25mg) was given epidurally.
Her heart rate rose immediately from 80 to 100.
After 30 minutes her midwife called an Anaesthetist to review because she was complaining of intense dizziness. She described her heart as racing (pulse now 120) and on direct questioning about numbness or tingling anywhere described tingling of her nose and cheeks.
Her blood pressure was unchanged at 120/80. She had no other symptoms.
100ml of intralipid was given as an IV bolus over 2 to 3 minutes.
Her dizziness immediately subsided, she opened her eyes and said she felt much better. Her blood pressure transiently rose to 180/100 after the bolus. Her heart rate settled to 100.
No further drugs were given epidurally. She had a normal delivery of a healthy baby.