Post Your Cases > LAST during suprascapular nerve block

I'm reporting LAST with intralipid rescue in a 72 yo man having a single shot suprascapular nerve block after reverse TSA. The block was performed under ultrasound guidance in the suprascapular fossa. After negative aspiration, 15 ml of 0.5% bupivacaine with 1:200,000 epi was incrementally injected. As we were finishing the injection, the patient began to have tonic/clonic movements of his head, upper extremity and lower extremity and became unconscious. HR remained stable in the 80's with no change of the EKG tracing on the 3-lead monitor and no ectopy. His respiratory effort and rate were preserved and he remained hemodynamically stable with 100% SpO2. Within 30-60 seconds of start of seizure, the patient received the first 30 ml of a total of 90 ml of intralipid solution given by rapid bolus through a syringe (three doses of 30 ml). By the end of the second syringe, the seizure had stopped. The patient was confused for the next 3-5 minutes, but then regained full consciousness. Vitals remained stable throughout. He was monitored for the next 60 minutes with no further sequelae.
January 9, 2018 | Unregistered CommenterMichael Buys
Thanks for posting this interesting case, Michael. One wouldn't think that 75mg of bupivacaine, is particularly toxic, but if we assume it was intravascular then the dosing limits are pretty much inapplicable since the tissue concentrations can jump pretty quickly - and with bupivacaine the LA can stay put. In any case, the resolution of seizures during injection of lipid is pretty typical - I've seen it twice myself....and once only a few months ago. Glad everything resolved and the patient was fine. Good work!
February 20, 2018 | Unregistered CommenterGuy