Levobupivacaine

Abstract

S LevobupivacaineRefractory hypotension, shortness of breath and sleepiness following levobupivacaine toxicity; treated with lipid emulsion: case report A 64-year-old woman developed refractory hypotension, shortness of breath and sleepiness following levobupivacaine toxicity. Eventually, treated with lipid emulsion.The woman was given epidural analgesia with 10mg of levobupivacaine (0.375%) in 5 ml increments during iliac artery revascularisation. A few minuted later, when draped in prone position, she complained of shortness of breath and sleepiness with rush and severe fall in BP and heart rate. Her BP was measured at 47/35 mmHg as opposed to a preoperative BP of 140/80 mmHg. The hypotension did not respond to sympathomimetic therapy.Circulatory stability was immediately restored with an infusion of 20% lipid emulsion. Surgical procedure was continued and intra-operative BP and heart rate was normal.Author comment: "We believe that [refractory hypotension, shortness of breath and sleepiness] was manifestation of levobupivacaine systemic toxicity."Glavas J, et al. Refractory hypotension after simultaneous administration of epidural levobupivacaine and intravenous amoxicillin mimicking anaphylactic reaction in vascular patient successfully treated with 20% lipid emulsion. Regional Anesthesia and Pain Medicine 40: e99, No. 5, Oct 2015. Available from: URL: http://doi.