Severe coronary artery spasm induced by epidural injection of bupivacaine hydrochloride: a case report

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Michael Mutlak1, Eugenia Nikolsky

  • 1Rambam Health Care Campus, Haifa, Israel.

Acute Cardiac Care
|April 27, 2011
PubMed

Insights

Epidural bupivacaine hydrochloride can trigger variant angina, a serious heart condition. This case highlights the importance of monitoring cardiac health during epidural anesthesia for back pain.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Pharmacology

Background:

  • Intractable low back pain management often involves epidural anesthesia.
  • Bupivacaine hydrochloride is a commonly used local anesthetic for epidural procedures.
  • Lumbar discopathy is a frequent cause of chronic low back pain.

Observation:

  • A 66-year-old male patient with lumbar discopathy developed variant angina during epidural bupivacaine hydrochloride infusion.
  • The patient experienced severe, reversible coronary artery spasm affecting the right coronary artery.
  • Coronary angiography confirmed the presence and extent of the coronary artery spasm.

Findings:

  • Epidural bupivacaine hydrochloride was identified as the likely trigger for variant angina in this patient.
  • The coronary artery spasm was severe but fully reversible upon discontinuation of the anesthetic.
  • Treatment with nitrates and calcium channel blockers effectively resolved the symptoms of variant angina.

Implications:

  • This case underscores the potential for epidural anesthetics, specifically bupivacaine, to induce cardiac complications like variant angina.
  • Clinicians should consider cardiac monitoring in patients receiving epidural anesthesia, especially those with pre-existing cardiovascular risk factors.
  • Further research may be warranted to elucidate the mechanisms underlying bupivacaine-induced coronary artery spasm and to establish screening protocols.

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