Anxiety, vocalization, and agitation following peripheral nerve block with ropivacaine

被引:22
作者
Klein, SM
Benveniste, H
机构
[1] Duke Univ, Med Ctr, Dept Anesthesiol, Durham, NC 27710 USA
[2] Duke Univ, Med Ctr, Dept Radiol, Durham, NC 27710 USA
关键词
peripheral nerve block; ropivacaine; anxiety; vocalization; agitation;
D O I
10.1016/S1098-7339(99)90081-0
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background and Objectives. Central nervous system (CNS) and cardiovascular toxicity are potential side effects of local anesthetics. However, ropivacaine has been reported to be less CNS toxic than bupivacaine in human volunteers. Methods. We describe three cases of peripheral nerve blockade with ropivacaine that resulted in unusual symptoms of CNS toxicity. Results. In three patients, unexpected behavioral changes occurred during administration of ropivacaine. The patients became extremely agitated, anxious, and screamed, and they did not repsond to Verbal commands. Conclusion: This case report shows that ropivacaine may cause CNS toxicity that differs from classical signs of local anesthetic-induced toxicity. This effect might be related to the unique structure of ropivacaine, which is formulated in an S-enantomer preparation. It has been shown that S-enantomers bind differently to receptors in both the CNS and cardiovascular systems. This property may account for the disinhibition of select neural pathways that are specifically involved in mediation of anxiety and aggression.
引用
收藏
页码:175 / 178
页数:4
相关论文
共 12 条
[1]   CHIRALITY IN ANESTHESIA [J].
CALVEY, TN .
ANAESTHESIA, 1992, 47 (02) :93-94
[2]  
Chauvel P, 1992, Adv Neurol, V57, P185
[3]  
DEJONG RH, 1994, LOCAL ANESTHETICS, P264
[4]   Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers [J].
Knudsen, K ;
Suurkula, MB ;
Blomberg, S ;
Sjovall, J ;
Edvardsson, N .
BRITISH JOURNAL OF ANAESTHESIA, 1997, 78 (05) :507-514
[5]   Convulsions induced by ropivacaine during interscalene brachial plexus block [J].
Korman, B ;
Riley, RH .
ANESTHESIA AND ANALGESIA, 1997, 85 (05) :1128-1129
[6]   CARDIAC ELECTROPHYSIOLOGIC PROPERTIES OF BUPIVACAINE AND LIDOCAINE COMPARED WITH THOSE OF ROPIVACAINE, A NEW AMIDE LOCAL-ANESTHETIC [J].
MOLLER, R ;
COVINO, BG .
ANESTHESIOLOGY, 1990, 72 (02) :322-329
[7]   Local anaesthetics potentiate GABA-mediated Cl- currents by inhibiting GABA uptake [J].
Nordmark, J ;
Rydqvist, B .
NEUROREPORT, 1997, 8 (02) :465-468
[8]  
REUTENS DC, 1996, ADV NEUROL, P293
[9]  
RUTTEN AJ, 1989, ANESTH ANALG, V69, P291
[10]   ACUTE TOXICITY OF ROPIVACAINE COMPARED WITH THAT OF BUPIVACAINE [J].
SCOTT, DB ;
LEE, A ;
FAGAN, D ;
BOWLER, GMR ;
BLOOMFIELD, P ;
LUNDH, R .
ANESTHESIA AND ANALGESIA, 1989, 69 (05) :563-569