Post Your Cases > Isolated CNS Toxicity 

21 yr old female underwent ACL reconstruction under FNB/SNB. Uneventful block placement with total of 60mls of 0.5% Ropivicaine and uneventful intraoperative course.75 minutes after block placement (without consulting anesthesia) the surgeon injected 30 mls of intra-articular 0.5% Bupivicaine. 30 minutes later in PACU pt noted to be restless,agitated, and less responsive.She then developed uncontrolled jerking motions of the head, neck, and shoulders.Intralipid 1.5ml/kg IVP times two and 3mg IV versed given, followed by intralipid infusion of 0.25mls/kg/min for 60 minutes.30 minutes after starting intralipid infusion the pt was AAO, following commands with no further signs of CNS agitation. Pt observed in PACU for 90 minutes after completion of intralipid infusion without further symptoms.
January 10, 2008 | Unregistered CommenterMIASC
hi, and thanks for posting.
was there any indication of cardiovascular compromise? i think this type of common scenario will be a starting point in departments all over the world for discussion about the timing and use of lipid infusion. i think you are completely justified in using this and in addition to any salutary effect on cns toxicity you may have prevented progression to cv collapse. however, we can never know for sure....though i would not want to wait to find out when the seizures are vigorous and progressiing in intensity as in this patient.
guy
January 14, 2008 | Registered Commenter[Guy Weinberg]
There were no signs of cardiovascular compromise.
The patient remained hemodynamically stable and although she was tachycardic during this episode, there were no ventricular arrhythmias.
February 18, 2008 | Unregistered CommenterMIASC