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• W2129918312 abstract "Different studies and case reports ascribed transient neurological manifestations (TNM) after neuraxial anaesthesia, at least in part, to lidocaine, bupivacaine, mepivacaine and recently to ropivacaine [1–5]. In fact, nerve conduction block could be the expression of a reversible toxic effect [5] and TNM are a moderate expression of this toxicity. During epidural anaesthesia, the transmeningeal transfer of local anaesthetics may result in elevated intrathecal concentrations [1] that probably contribute to TNM. We report here a case of TNM after epidural ropivacaine. A 58-year-old, ASA II, male patient, underwent a radical prostatectomy under general anaesthesia. The patient was in the supine position peroperatively. The patient's medical history included hypertension and tetracycline hypersensitivity, general anaesthesia for colonoscopy, a thumb fracture reduction, a laparotomy for Meckel's diverticulum, a prostate biopsy, no alcohol intake, he stopped smoking 3 years ago, and his current medication was bisoprolol. Prior to general anaesthesia, we inserted an epidural catheter through a 17 gauge Tuohy needle in the L3–L4 interspace for postoperative analgesia. We carried out a single needle pass and there was no difficulty in threading the catheter. No pain, paraesthesia or bleeding was elicited at any time. The epidural space was identified using loss of resistance to air. After a test dose of 3 ml lidocaine 1% with epinephrine 1 : 200 000, which was negative for intrathecal or intravascular injection, a bolus of 7 ml ropivacaine 0.75% was injected through the epidural catheter, resulting in a T10 level of analgesia. One hour after the initial dose, we started a continuous epidural infusion of ropivacaine 0.2% (the pump speed was 5 ml.h−1). Ten hours after starting the pump, the patient complained of slight pain, so proparacetamol 2 g was given twice and the pump speed increased to 7 ml.h−1. Epidural analgesia lasted for 72 h. Twelve hours after discontinuing the epidural ropivacaine, the patient described a violent bilateral burning sensation and pain in the back and the thighs, which spread quickly to the legs and feet. The movement of the lower extremities, the examiner's hand pressure on the limbs, and the orthostatic position of the patient exacerbated this pain. We did not find any reflex or motor abnormalities, or neurological deficit. The patient was treated with two doses of subcutaneous morphine 10 mg, and intravenous ketoprofen 100 mg. Symptoms started to diminish progressively and disappeared 12 h later without leaving any sequelae. On follow-up 2 weeks later, the patient did not mention any pain or neurological problem." @default.
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• W2129918312 date "2002-03-01" @default.
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• W2129918312 title "Transient neurological manifestations after epidural analgesia with ropivacaine" @default.
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• W2129918312 doi "https://doi.org/10.1111/j.1365-2044.2002.2520_35.x" @default.
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