Ropivacaine-induced convulsion immediately after epidural administration--a case report

Ropivacaine is a new long-acting amide-type local anesthetic with less toxic effects compared with bupivacaine. Here, we report a case who sustained convulsion immediately after administration of epidural ropivacaine. A 75-year-old woman was scheduled for total knee replacement. Epidural catheter was inserted smoothly. After aspiration test and injection of a test dose of 3 ml of 2% lidocaine containing 15 micrograms epinephrine, 160 mg ropivacaine was administered epidurally. Unfortunately, a generalized tonic-clonic convulsion of sudden onset occurred right after ropivacaine injection. After he was given 100% oxygen and intravenous thiopental 150 mg, the patient recovered uneventfully. During the episode of convulsion sinus tachycardia at a rate of 120 beats/min without the interposal of other form of cardiac arrhythmia was noted, and respiration remained intact. This suggests that ropivacaine offers a good cardiovascular stability. This example serves as another evidence to remind us that even with a negative aspiration following epidural catheter placement and an uneventful test dose injection, inadvertent intravascular injection may still happen, particularly in the elderly.