Resuscitation following a bupivacaine injection for a cervical paravertebral block

Vosylius, Saulius; Uvarovas, Valentinas; Švedienė, Saulė; Šatkauskas, Igoris

doi:10.1515/med-2019-0112

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…One of the most serious complications of this blockade described is the injection of a local anesthetic directly into the spinal cord with permanent loss of cervical spinal cord function [36]. There have been also reports of cardiac arrest following intravascular bupivacaine administration during cervical paravertebral blockade [37].…”

Section: Cervical Paravertebral Block (Cpvb)mentioning

confidence: 99%

Ultrasound-Guided Blocks for Spine Surgery: Part 1—Cervix

Adamczyk

Koszela

Zaczyński

et al. 2023

IJERPH

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Postoperative pain is common following spine surgery, particularly complex procedures. The main anesthetic efforts are focused on applying multimodal analgesia beforehand, and regional anesthesia is a critical component of it. The purpose of this study is to examine the existing techniques for regional anesthesia in cervical spine surgery and to determine their effect and safety on pain reduction and postoperative patient's recovery. The electronic databases were searched for all literature pertaining to cervical nerve block procedures. The following peripheral, cervical nerve blocks were selected and described: paravertebral block, cervical plexus clock, paraspinal interfascial plane blocks such as multifidus cervicis, retrolaminar, inter-semispinal and interfacial, as well as erector spinae plane block and stellate ganglion block. Clinicians should choose more superficial techniques in the cervical region, as they have been shown to be comparably effective and less hazardous compared to paravertebral blocks

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Section: Cervical Paravertebral Block (Cpvb)mentioning

confidence: 99%

Ultrasound-Guided Blocks for Spine Surgery: Part 1—Cervix

Adamczyk

Koszela

Zaczyński

et al. 2023

IJERPH

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“…Between December 2017 and May 2020, there were a further 36 cases of LAST reported in 34 peer‐reviewed published articles [6–39]. These data indicated 30% of patients were older than 65 y, and 6% were younger than 5 y. Sixty‐one percent of cases occurred in the hospital; 17% in outpatient surgery centres; and 14% in outpatient clinics (e.g.…”

Section: Clinical Presentationmentioning

confidence: 99%

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

et al. 2021

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Summary Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non‐anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at‐risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.

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“…The American Society of Regional Anesthesia and Pain Medicine (ASRA), updated in 2017, emphasized the importance of lipid emulsions in the LAST management checklist, indicating that prioritizing airway management and early infusion of lipid emulsions can effectively prevent the vicious circle of hypoxia and acidosis symptoms in the late stage of poisoning ( 22 ). Therefore, hospitals that use local anesthetics for regional anesthesia or pain management should stock lipid emulsion preparations ( 23 , 24 ).…”

Section: Local Anesthetic Systemic Toxicity (Last)mentioning

confidence: 99%

Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics

Liu

Zhang

et al. 2021

Front. Med.

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Local anesthetics are widely used clinically for perioperative analgesia to achieve comfort in medical treatment. However, when the concentration of local anesthetics in the blood exceeds the tolerance of the body, local anesthetic systemic toxicity (LAST) will occur. With the development and popularization of positioning technology under direct ultrasound, the risks and cases of LAST associated with direct entry of the anesthetic into the blood vessel have been reduced. Clinical occurrence of LAST usually presents as a series of severe toxic reactions such as myocardial depression, which is life-threatening. In addition to basic life support (airway management, advanced cardiac life support, etc.), intravenous lipid emulsion (ILE) has been introduced as a treatment option in recent years and has gradually become the first-line treatment for LAST. This review introduces the mechanisms of LAST and identifies the clinical symptoms displayed by the central nervous system and cardiovascular system. The paper features the multimodal mechanism of LAST reversal by ILE, describes research progress in the field, and identifies other anesthetics involved in the resuscitation process of LAST. Finally, the review presents key issues in lipid therapy. Although ILE has achieved notable success in the treatment of LAST, adverse reactions and contraindications also exist; therefore, ILE requires a high degree of attention during use. More in-depth research on the treatment mechanism of ILE, the resuscitation dosage and method of ILE, and the combined use with other resuscitation measures is needed to improve the efficacy and safety of clinical resuscitation after LAST in the future.

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Resuscitation following a bupivacaine injection for a cervical paravertebral block

Abstract: AbstractBackgroundCardiac arrest related to nerve blockade using a local anaesthetic is a rare event. We report a case of bupivacaine severe cardiovascular toxicity following cervical paravertebral nerve block.Case presentationA 44-year-old female was admitted to Republ… Show more

Cited by 4 publications

References 17 publications

Ultrasound-Guided Blocks for Spine Surgery: Part 1—Cervix

Ultrasound-Guided Blocks for Spine Surgery: Part 1—Cervix

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics

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