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Brugada-type electrocardiographic pattern induced by epidural bupivacaine
Nicole Phillips1, Mark Priestley, A Robert Denniss
1Department of Anesthesia, Westmead Hospital, Australia. nicolephillips@optusnet.com.au
Anesthesia and Analgesia
|June 24, 2003
Summary
Continuous epidural bupivacaine infusion can cause Brugada syndrome-like ECG changes in susceptible patients. These changes reversed after stopping the bupivacaine, highlighting local anesthetic risks for arrhythmias.
Area of Science:
- Cardiology
- Anesthesiology
- Clinical Electrophysiology
Background:
- Brugada syndrome is a genetic disorder characterized by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death.
- Continuous epidural infusions are commonly used for postoperative pain management.
Observation:
- A patient receiving a continuous epidural bupivacaine infusion developed ECG changes suggestive of Brugada syndrome postoperatively.
- The patient had a history of incomplete right bundle branch block but was otherwise unremarkable.
Findings:
- The observed electrocardiogram changes were reversible upon discontinuation of the bupivacaine infusion.
- This suggests a potential causal link between bupivacaine administration and the Brugada-like ECG manifestations.
Implications:
- Local anesthetics, specifically bupivacaine, may unmask or induce serious arrhythmias in individuals with underlying Brugada syndrome.
- Clinicians should be aware of this potential risk when administering bupivacaine to patients with or at risk for Brugada syndrome.