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Persistent hiccups associated with epidural ropivacaine in a newborn

Dayanand N Bagdure1, Pamela D Reiter, Girija R Bhoite

  • 1Pediatric Intensive Care Unit, Section of Critical Care Medicine, The Children's Hospital, Aurora, CO, USA. bagdure.dayanand@tchden.org

The Annals of Pharmacotherapy
|June 10, 2011
PubMed

Insights

Persistent hiccups in a newborn were likely caused by epidural ropivacaine, a common anesthetic. Reducing the ropivacaine dose resolved the hiccups, suggesting a neurotoxic effect in infants.

Area of Science:

  • Anesthesiology
  • Pediatric Neurology

Background:

  • Epidural ropivacaine is frequently used for pediatric pain management.
  • Neurotoxicity is a potential adverse effect of local anesthetics.

Observation:

  • A term infant developed persistent hiccups, hypotonia, and lip trembling after receiving epidural ropivacaine for surgical pain.
  • Electroencephalogram results were negative for seizure activity.

Findings:

  • A causal link between epidural ropivacaine administration and persistent hiccups was established using the Naranjo probability scale.
  • Reducing the ropivacaine infusion rate led to a significant improvement in the infant's symptoms.

Implications:

  • This case highlights persistent hiccups as a potential indicator of ropivacaine neurotoxicity in neonates.
  • Clinicians should monitor for neurological side effects when using epidural ropivacaine in infants.
Abstract

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