Systemic local anaesthetic toxicity from continuous thoracic paravertebral block

British Journal of Anaesthesia
P J FagenholzW S Walker

Abstract

Continuous paravertebral block is commonly used for post-thoracotomy analgesia and compares favourably with other systemic and regional methods with regard to safety and efficacy. No major complications of continuous paravertebral block for post-thoracotomy analgesia have been reported previously. We report here a case of systemic local anaesthetic toxicity from continuous paravertebral block administration after thoracotomy and lobectomy leading to seizure, aspiration, and ultimately, death. Potential contributing factors in this case included small patient size, concomitant antifungal therapy, extensive surgical disruption of the pleurae, and inappropriate paravertebral bolus administration. Postoperative delirium was a diagnostic confounder. We discuss the potential causes and means of avoiding similar complications in the future.

References

Aug 1, 1992·Anesthesia and Analgesia·R AgarwalC H Lockhart
Apr 1, 1997·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·A DauphinW D Morton
Feb 16, 2000·British Journal of Anaesthesia·V J PalkamaK T Olkkola
Oct 7, 2006·Journal of Cardiothoracic and Vascular Anesthesia·Marta García NavletLeticia Gomez-Caro
Jan 19, 2008·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Juan J FiblaGonzalo Vidal
Feb 13, 2010·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Derek Dillane, Brendan T Finucane
Jan 15, 2011·British Journal of Anaesthesia·J RichardsonZ Naja
Feb 4, 2011·British Journal of Anaesthesia·E S PowellUNKNOWN UKPOS Investigators

❮ Previous
Next ❯

Citations

Feb 6, 2013·Der Anaesthesist·F ReisigUNKNOWN Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin
Apr 12, 2013·Acta Anaesthesiologica Scandinavica·Harald Breivik, Hilde Norum
Nov 2, 2014·International Journal of Cancer. Journal International Du Cancer·Wei XuanDaqing Ma
May 16, 2013·Current Opinion in Anaesthesiology·Jason J ChoiJeff Gadsden
Dec 4, 2013·Current Opinion in Anaesthesiology·Cory Maxwell, Alina Nicoara
May 26, 2018·Scandinavian Journal of Pain·Harald BreivikMichael Lagerkranser
Jul 6, 2020·Journal of Cardiothoracic and Vascular Anesthesia·Thomas J CarusoBan C H Tsui

❮ Previous
Next ❯

Related Concepts

Related Feeds

Antifungals

An antifungal, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis, cryptococcal meningitis, and others. Discover the latest research on antifungals here.

Antifungals (ASM)

An antifungal, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis, cryptococcal meningitis, and others. Discover the latest research on antifungals here.