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Systemic ropivacaine toxicity from a peripheral nerve infusion in a medically complex patient
Eliot Grigg1, Corrie Anderson1, Martha Pankovich1
1Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, MS 9824, Seattle, WA 98105.
Abstract:
This is a case of systemic ropivacaine toxicity from a sciatic nerve catheter. A 20-year-old patient after heart transplant with poor systemic perfusion on hemodialysis and multiple medications experienced local anesthetic systemic toxicity 72 hours after placement of a peripheral nerve catheter. The case demonstrates the potentially significant impact of medical comorbidities on system absorption of local anesthetics and reinforces that existing dose guidelines are not evidence based, and literature to guide local anesthetic bolus supplementation of continuous infusions is scant.
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