Accident aigu toxique après bloc du plexus lombaire à la bupivacaïne

Pham-Dang, Charles; Beaumont, S; Floch, H; Bodin, J M; Winer, Arnaud; Pinaud, M.

doi:10.1016/s0750-7658(00)90203-x

Cited by 45 publications

(4 citation statements)

References 18 publications

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“…For instance, there are no case reports of toxicity after popliteal sciatic blockade, whereas there are several case reports of severe toxicity following lumbar plexus and proximal sciatic blocks. [165][166][167][168][169] Anatomic differences in the anatomy, primarily in the vascularity and presence of deep muscle beds in the area of blockade, are the most likely explanation for this discrepancy. Severe toxic reactions typically occur during the injection or immediately thereafter.…”

Section: Complications Of Lower-extremity Peripheral Nerve Blocksmentioning

confidence: 99%

Lower-extremity peripheral nerve blockade: Essentials of our current understanding

Enneking

Chan

Greger³

et al. 2005

Regional Anesthesia and Pain Medicine

102

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Section: Complications Of Lower-extremity Peripheral Nerve Blocksmentioning

confidence: 99%

Lower-extremity peripheral nerve blockade: Essentials of our current understanding

Enneking

Chan

Greger³

et al. 2005

Regional Anesthesia and Pain Medicine

102

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“…In spite of more effectiveness of the PCB, the inguinal paravascular and ACB is still commonly performed for fear of side effects of PCB. [ 18 19 20 21 ] One of the most common and most serious side effects are the epidural/spinal spread of local anesthetic solution, which is mainly due to a proximal movement into the paravertebral space rather than a direct placement of the needle into the epidural space,[ 19 ] delayed bilateral spread of local anesthetic,[ 22 ] intravascular injections can cause seizure, cardiac arrest, and death,[ 23 24 25 ] delayed toxic reactions, unilateral sympathectomy,[ 5 ] and renal subcapsular hematoma. [ 20 21 ] To decrease the incidence of these complications associated with lumbar plexus block, ultrasound guidance has been introduced which allows direct visualization of the needle, anatomy, neural structures, and the spread of local anesthetics.…”

Section: Discussionmentioning

confidence: 99%

Real-time ultrasound-guided comparison of adductor canal block and psoas compartment block combined with sciatic nerve block in laparoscopic knee surgeries

Messeha

2016

Anesth Essays Res

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Background:Lumbar plexus block, combined with a sciatic nerve block, is an effective locoregional anesthetic technique for analgesia and anesthesia of the lower extremity. The aim of this study was to compare the clinical results outcome of the adductor canal block versus the psoas compartment block combined with sciatic nerve block using real time ultrasound guidance in patients undergoing elective laparoscopic knee surgeries.Patients and Methods:Ninety patients who were undergoing elective laparoscopic knee surgeries were randomly allocated to receive a sciatic nerve block in addition to lumbar plexus block using either an adductor canal block (ACB) or a posterior psoas compartment approach (PCB) using 25 ml of bupivacine 0.5% with adrenaline 1:400,000 injection over 2-3 minutes while observing the distribution of the local anesthetic in real time. Successful nerve block was defined as a complete loss of pinprick sensation in the region that is supplied by the three nerves along with adequate motor block, 30 minutes after injection. The degree of motor block was evaluated 30 minutes after the block procedure. The results of the present study showed that the real time ultrasound guidance of PCB is more effective than ACB approach. Although the sensory blockade of the femoral nerve achieved equally by both techniques, the LFC and OBT nerves were faster and more effectively blocked with PCB technique. Also PCB group showed significant complete sensory block without need for general anesthesia, significant decrease in the post-operative VAS and significant increase time of first analgesic requirement as compared to the ACB group.Result and Conclusion:The present study demonstrates that blockade of lumber plexus by psoas compartment block is more effective in complete sensory block without general anesthesia supplementation in addition to decrease post-operative analgesic requirement than adductor canal block.

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“…Deleterious effects of accidental intravenous administration of bupivacaine leading to severe cardiovascular collapse and shock are well documented [11-13]. Various agents have been evaluated for alleviating the cardiotoxic effects of bupivacaine in both animal studies and human case series.…”

Section: Discussionmentioning

confidence: 99%

The effects of levosimendan and dobutamine in experimental bupivacaine-induced cardiotoxicity

et al. 2013

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BackgroundAccidental intravenous exposure to bupivacaine is highly cardiotoxic and may lead to death. Positive inotropic agents are usually utilized in resuscitative efforts. We have compared the efficacy of levosimendan, a novel inotropic agent, with dobutamine and their combination in a rat model of bupivacaine intoxication.MethodsTwenty-eight male Wistar albino rats weighing between 250-300 g were divided into these four groups: control (C), levosimendan (L), dobutamine (D) and dobutamine+levosimendan (D+L). Bupivacaine was administered at a dose of 3 mg/kg/min until cardiac arrest occurred or for 120 min. ECG, heart rate, blood pressure, arterial blood gases, and end tidal CO2 levels were monitored. Levosimendan was administered as a bolus of 12 μg/kg for 10 min and continued as an infusion at 0.3 μg/kg/min. Dobutamine was infused at a dose of 3 μg/kg/min. The time required for a 50% and 75% decrease in heart rate and blood pressure with a total time to cardiac arrest and bupivacaine dose for obtaining cardiac arrest were analyzed.ResultsTime periods for heart rate reductions of 50% and 75% were significantly longer in groups L (903, 1198 s), D (984, 1542 s) and L+D (1705, 3152 s) compared with the control group (345, 538 s p < 0.001). Median times to mean blood pressure reductions of 50% and 75% were 399 - 504 s in the control group, 1005 -1204 s in group L, 685 - 1009 s in group D and 1544- 2982 s in group L+D, and the difference was significant compared with the control group. Median time duration to asystole was 703 s in the control group compared with 1385 s in group L, 1789 s in group D and 3557 s in group L+D. Time to cardiac arrest was significantly higher in all 3 study groups. It was also significantly higher in the L+D group compared with both groups L and D separately.ConclusionA combination of dobutamine with levosimendan significantly increased survival times in this bupivacaine-induced toxicity rat model compared with the control, levosimendan, and dobutamine groups.

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Accident aigu toxique après bloc du plexus lombaire à la bupivacaïne

Cited by 45 publications

References 18 publications

Lower-extremity peripheral nerve blockade: Essentials of our current understanding

Lower-extremity peripheral nerve blockade: Essentials of our current understanding

Real-time ultrasound-guided comparison of adductor canal block and psoas compartment block combined with sciatic nerve block in laparoscopic knee surgeries

The effects of levosimendan and dobutamine in experimental bupivacaine-induced cardiotoxicity

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