Ahmet Cemil İSBİR, Caner MİMAROĞLU, Cevdet DÜGER, İclal KOL ÖZDEMİR, Sinan GÜRSOY, Kenan KAYGUSUZ

Convulsion due to levobupivacaine in axillary brachial plexus block: Case report

Brakiyal pleksusun aksiler yaklaşım ile bloğu el, ön kol ve kolun 1/3 distalinde yapılacak cerrahideetkin bir anestezi yöntemidir. Bununla birlikte kardiyovasküler ve santral sinir sistemi toksisitesigibi ciddi komplikasyon riskleride bulunmaktadır. Levobupivakain amid yapılı epidural, kaudal,spinal, infiltrasyon ve periferik sinir bloklarında kullanılan uzun etkili bir lokal anesteziktir.Levobupivakain rasemik bupivakainin S (-) izomeridir ve kardiyotoksisite ve santral sinir sistemitoksisitesi riskinin bupivakaine göre azalmış olmasına karşın levobupivakain sonrası ilacınsistemik dolaşıma karışması ile santral sinir sistemi toksisitesi vakaları bildirilmektedir. Buradaaksiller brakiyal pleksus blokajı yapılan bir olguda işlem anında herhangi bir damar ponksiyonuolmamasına rağmen kullanılan levobupivakaine bağlı işlem sonrasında gelişen konvülziyonolgusunu sunmaktayız.

Aksiller brakiyal pleksus blokaj ında levobup ivakaine bağlı konvülziyon: Olgu sunumu

Axillary brachial plexus block is an effective method of anaesthesia for the surgeries performed onthe hand, forearm and distal third of the arm. However it has the risk of serious complications suchas cardiovascular and central nervous system toxicity. Levobupivacaine is a long acting amidelocal anaesthetic used for epidural, caudal, spinal, infiltration and peripheral nerve blocks.Levobupivacaine is the S (-) isomer of racemic bupivacaine and has a lower risk of cardiovascular,central nervous system toxicity than bupivacaine. However central system toxicity cases due toabsorption of the drug into the systemic circulation has been reported. Here, we report a casehaving no vascular puncture during axillary brachial plexus block performance but developingconvulsion due to levobupivacain after the intervention.

PDF

___

1. Gürsoy S, Kaygusuz K, Aldemir B, Öztürk H, Kafalı H, Mimaroğlu C. Aksiller Brakiyal Pleksus Bloğunda Lidokaine İlave Edilen Ketaminin İntraoperatif ve Postoperatif Etkileri. C. Ü. Tıp Fakültesi Dergisi 2005, 27: 147-52.
2. Janzen PR, Vipond AJ, Bush DJ, Hopkins PM. A comparison of 1% prilocaine with 0.5% ropivacaine for outpatient-based surgery under axillary brachial plexus block. Anesth Analg 2001; 93: 187-91.
3. Huang YF, Pryor ME, Mather LE, Veering BT. Cardiovascular and Central Nervous System Effects of Intravenous Levobupivacaine and Bupivacaine in Sheep. Anesth Analg 1998; 86: 797-804.
4. Crews JC, Rothman TE. Seizure after levobupivacaine for interscalene brachial plexus block. Anesth Analg 2003; 96: 1188-90.
5. Kocamanoglu IS, Sarihasan B. Lokal Anestezikler: Yeni Bir Lokal Anestezik; Levobupivakain. O.M.Ü. Tip Dergisi 2007; 24: 27-36.
6. Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs 2000; 59: 551-79.
7. Müller M, Litz RJ, Hüler M, Albrecht DM. Grand mal convulsion and plasma concentrations after intravascular injection of ropivacaine for axillary brachial plexus blockade. Br J Anaesth 2001; 87: 784-7.
8. Brown DL, Ransom DM, Hall JA, Leicht CH, Schroeder DR, Offord KP. Regional anesthesia and local anesthetic-induced systemic toxicity: seizure frequency and accompanying cardiovascular changes. Anesth Analg 1995; 81: 321-8.
9. Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier FJ, Bouaziz H, Samii K. Major complications of regional anesthesia in France: the SOS Regional Anesthesia Hotline Service. Anesthesiology 2002; 97: 1274-80.
10. Knudsen K, Beckman Suurküla M, Blomberg S, Sjövall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997; 78: 507-14.
11. Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69: 563-9.
12. Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol 1998; 46: 245-9.
13. Stewart J, Kellett N, Castro D. The central nervous system and cardiovascular effects of levobupivacaine and ropivacaine in healthy volunteers. Anesth Analg 2003; 97: 412-6.
14. Copeland SE, Ladd LA, Gu XQ, Mather LE. The effects of general anesthesia on the central nervous and cardiovascular system toxicity of local anesthetics. Anesth Analg 2008; 106: 1429-39.