Anesth Pain Med.  2022 Apr;17(2):228-234. 10.17085/apm.21093.

Two cases of late-onset cardiovascular toxicities after a single injection of local anesthetics during supraclavicular brachial plexus block - A report of two cases -

• Kim JY
• Park BI
• Heo MH
• Kim KW
• Lee SI
• Kim KT
• Choe WJ
• Park JS
• Kim JH

• KMID: 2531700
• DOI: http://doi.org/10.17085/apm.21093

Abstract

Background
Local anesthetics systemic toxicity (LAST) is a grave complication of regional anesthesia that usually occurs immediately after local anesthetics injection. Here, we report on rare late-onset toxicity cases after supraclavicular brachial plexus blocks. Case: Two patients underwent surgery for radius fractures. We used lidocaine 100 mg and ropivacaine 150 mg for blocking and infused dexmedetomidine for intraoperative sedation. The 63-year-old male patient’s blood pressure dropped to 87/60 mmHg after 3 h 15 min after blocking. Ventricular fibrillation occurred 10 min later. After five defibrillations, electrocardiography showed ventricular tachycardia that was normalized through one cardioversion. The 54-year-old female patient’s heart rate decreased to 35 beats/min 2 h 30 min after blocking. Her vital signs returned to normal after administering atropine, ephedrine, epinephrine, and lipid emulsion. Conclusions: Physicians should remember that LAST may occur long after local anesthetic injection and be aware of factors that may adversely affect the course of LAST.

Keyword

Adverse effects; Brachial plexus block; Lidocaine; Local anesthetic; Ropivacaine; Toxicity

Figure

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  Fig. 1. Ultrasonography image of supraclavicular brachial plexus with color doppler. BP: brachial plexus, SA: subclavian artery.

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  Fig. 2. Electrocardiography of the patient. (A) Ventricular fibrillation. (B) Ventricular tachycardia. (C) QT prolongation: heart rate-corrected QT interval = 484 milliseconds.

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  Fig. 3. Timeline of the first case. BP: blood pressure, CPR: cardiopulmonary resuscitation, Defib: defibrillation, Epi: epinephrine, ICU: intensive care unit, IV: intravenously, ROSC: return of spontaneous circulation, V. Fib: ventricular fibrillation, V. Tac: ventricular tachycardia. *Indicates time after the local anesthetics injection.

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  Fig. 4. Timeline of the second case. HR: heart rate, IV: intravenously, NIBP: non-invasive blood pressure, PACU: post-anesthesia care unit. *Indicates time after the local anesthetics injection.

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