A Case of Late-Onset Local Anesthetic Toxicity Observed as Seizure Activity

Abstract

Most of the local anesthetic toxicity cases develop within the first five minutes of peripheral block administration. Late local anesthetic toxicity has been rarely reported in the literature. However, it is an important life-threatening problem that can lead to seizures, hemodynamic collapse, and cardiac arrest if it is ignored and not considered. Here we present the case of an 18-year-old male patient who had ultrasonography-guided infraclavicular brachial plexus block administration with a 30 mL local anesthetic. The patient had convulsions 210 minutes after the block administration and was treated with intravenous diazepam. Intraoperative and postoperative courses were uneventful. He had no neurologic signs or symptoms afterward. All laboratory tests and radiologic investigation tests were normal. This report demonstrates that late local anesthetic toxicity is still possible after several hours of the uneventful peripheral neural blockade, although it is rarely reported.

Examination of the effect of bupivacaine on brain tissue in rats with induced experimental renal failure

“…While LAST is presented with CNS symptoms in 77% of cases, the most common manifestation is seizures, seen in 53-68% of cases [17,18]. The literature includes numerous case presentations discussing clinical manifestations related to LAST [19][20][21] as well as studies investigating neurotoxicity on motor neurons due to intrathecal use [22][23][24]. However, studies investigating the CNS histopathology associated with local anesthetics are limited.…”