Greater cervical nerve block with bupivacaine resulting in neurotoxicity: A case report
Background: Local anesthetics are critical in the management of acute and chronic pain in various procedures and medical specialties. Their anesthetic properties derive from the ability to reversibly block sodium channels embedded within nerve fibers, and thus inhibit the conduction of painful stimu...
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Elsevier
2023-06-01
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| Series: | JEM Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773232023000238 |
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| author | Alexander T. Clark Aaron J. Lacy Michael D. Simpson Sara G. Lin James O. Jordano Saralyn R. Williams |
| author_facet | Alexander T. Clark Aaron J. Lacy Michael D. Simpson Sara G. Lin James O. Jordano Saralyn R. Williams |
| author_sort | Alexander T. Clark |
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| description | Background: Local anesthetics are critical in the management of acute and chronic pain in various procedures and medical specialties. Their anesthetic properties derive from the ability to reversibly block sodium channels embedded within nerve fibers, and thus inhibit the conduction of painful stimuli from an affected area. In supratherapeutic dosing, local anesthetic toxicity is directly related to the drug's propensity to distribute systemically. Onset and amplitude of toxicity may be increased in the setting of inadvertent intra-circulatory injection. One toxic manifestation is the direct inoculation of local anesthetics within the central nervous system (CNS). Case report: We present the case of a 34-year-old-female with neurotoxicity secondary to bupivacaine injection during a greater occipital nerve block. Emergent management of the patient required intubation, seizure control, and intravenous lipid emulsion therapy. Why should an emergency physician be aware of this?: Direct central nervous system (CNS) toxicity from local anesthetics leads to rapid clinical decline and the need for extensive immediate resuscitative efforts. Early in the resuscitation, emergency physicians must recognize that the symptoms of local anesthetic toxicity require prompt specialty consultation with medical toxicologists and treatment with intralipid therapy to help reduce morbidity and mortality. Knowledge of toxic doses of local anesthetic and the dose related toxic effects can prompt recognition of either direct CNS or intra-vessel injection. |
| format | Article |
| id | doaj-art-055e9853f3e749b39b75cefe47b8d227 |
| institution | Kabale University |
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| language | English |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
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| series | JEM Reports |
| spelling | doaj-art-055e9853f3e749b39b75cefe47b8d2272024-11-22T07:40:17ZengElsevierJEM Reports2773-23202023-06-0122100027Greater cervical nerve block with bupivacaine resulting in neurotoxicity: A case reportAlexander T. Clark0Aaron J. Lacy1Michael D. Simpson2Sara G. Lin3James O. Jordano4Saralyn R. Williams5Department of Emergency Medicine, Vanderbilt University Medical Center, 1313 21st Ave, South, 703 Oxford House, Nashville, TN, 37232-4700, USADepartment of Emergency Medicine, Washington University School of Medicine in St Louis, 660 Euclid Ave, St Louis, MO, 63110-1010, USA; Corresponding author.Division of Medical Toxicology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USADepartment of Emergency Medicine, Vanderbilt University Medical Center, 1313 21st Ave, South, 703 Oxford House, Nashville, TN, 37232-4700, USADepartment of Emergency Medicine, Vanderbilt University Medical Center, 1313 21st Ave, South, 703 Oxford House, Nashville, TN, 37232-4700, USADepartment of Emergency Medicine, Vanderbilt University Medical Center, 1313 21st Ave, South, 703 Oxford House, Nashville, TN, 37232-4700, USABackground: Local anesthetics are critical in the management of acute and chronic pain in various procedures and medical specialties. Their anesthetic properties derive from the ability to reversibly block sodium channels embedded within nerve fibers, and thus inhibit the conduction of painful stimuli from an affected area. In supratherapeutic dosing, local anesthetic toxicity is directly related to the drug's propensity to distribute systemically. Onset and amplitude of toxicity may be increased in the setting of inadvertent intra-circulatory injection. One toxic manifestation is the direct inoculation of local anesthetics within the central nervous system (CNS). Case report: We present the case of a 34-year-old-female with neurotoxicity secondary to bupivacaine injection during a greater occipital nerve block. Emergent management of the patient required intubation, seizure control, and intravenous lipid emulsion therapy. Why should an emergency physician be aware of this?: Direct central nervous system (CNS) toxicity from local anesthetics leads to rapid clinical decline and the need for extensive immediate resuscitative efforts. Early in the resuscitation, emergency physicians must recognize that the symptoms of local anesthetic toxicity require prompt specialty consultation with medical toxicologists and treatment with intralipid therapy to help reduce morbidity and mortality. Knowledge of toxic doses of local anesthetic and the dose related toxic effects can prompt recognition of either direct CNS or intra-vessel injection.http://www.sciencedirect.com/science/article/pii/S2773232023000238Local anestheticToxicityBupivacaineSeizureLASTCNS |
| spellingShingle | Alexander T. Clark Aaron J. Lacy Michael D. Simpson Sara G. Lin James O. Jordano Saralyn R. Williams Greater cervical nerve block with bupivacaine resulting in neurotoxicity: A case report JEM Reports Local anesthetic Toxicity Bupivacaine Seizure LAST CNS |
| title | Greater cervical nerve block with bupivacaine resulting in neurotoxicity: A case report |
| title_full | Greater cervical nerve block with bupivacaine resulting in neurotoxicity: A case report |
| title_fullStr | Greater cervical nerve block with bupivacaine resulting in neurotoxicity: A case report |
| title_full_unstemmed | Greater cervical nerve block with bupivacaine resulting in neurotoxicity: A case report |
| title_short | Greater cervical nerve block with bupivacaine resulting in neurotoxicity: A case report |
| title_sort | greater cervical nerve block with bupivacaine resulting in neurotoxicity a case report |
| topic | Local anesthetic Toxicity Bupivacaine Seizure LAST CNS |
| url | http://www.sciencedirect.com/science/article/pii/S2773232023000238 |
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