Hypertensive crisis merging paroxysmal supraventricular tachycardia after dezocine injection during caesarean delivery: a case report

Abstract

Background: Dezocine is a novel opioid receptor-antagonistic analgesic, which is widely used in clinic work. However, its usage in cesarean section is rare.Case presentation: A 28-year-old woman of 38 weeks' gestation (163cm, 79kg) underwent emergency cesarean section because of pelvic outlet stenosis in November 2021. There was no history of preeclampsia, anticoagulation, or hemorrhagic diathesis. The most recent electrocardiogram (ECG) during pregnancy was sinus tachycardia, and the heart rate (HR) was 108 beats/min. After the accomplishment of spinal anesthesia, the cesarean section started smoothly. After the fetus was delivered, the patient complained of pain when suturing the skin. The anesthesiologist gave her dezocine 5mg and the parturient presented with hypertensive crisis merging paroxysmal supraventricular tachycardia (PSVT). The fastest HR was 178 beats/min and the highest blood pressure (BP) was 190/128mmHg. After Esmolol 20mg and Urapidil 12.5mg were administrated, her HR and BP returned normal range 3min later. After observation, the patient returned to the ward one hour later and left hospital after 5 days. The patient denied the history of PSVT and hyperthyroidism.Conclusion: Nowadays，dizocine has been widely used in the area of postoperative analgesia. However, its usage is rare in obstetrics and gynecology. The malignant adverse reactions of dizocine needs to be highly vigilant.