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Cardiac arrest after thoracic paravertebral block with ropivacaine in a 6-year-old child

Yu Yamane1, Tetsuro Kagawa1

  • 1Department of Anesthesiology, Hyogo Prefectural Kobe Children's Hospital, 1-1-1, Takakuradai, Suma-ku, Kobe, Hyogo 654-0081 Japan.

JA Clinical Reports
|March 3, 2018
PubMed

Insights

Continuous thoracic paravertebral block (TPVB) with ropivacaine can lead to cardiac arrest if accidentally injected into a blood vessel. Prompt resuscitation with adrenaline and lipid emulsion is crucial for patient survival.

Area of Science:

  • Anesthesiology
  • Cardiology
  • Pediatric Surgery

Background:

  • Continuous thoracic paravertebral block (TPVB) is used for analgesia.
  • Sick sinus syndrome (SSS) is a cardiac condition requiring pacemaker implantation.
  • Ropivacaine is a local anesthetic commonly used in TPVB.

Purpose of the Study:

  • To report a case of cardiac arrest following TPVB.
  • To highlight the risk of inadvertent intravascular administration of ropivacaine.
  • To emphasize successful resuscitation strategies.

Main Methods:

  • A 6-year-old female received continuous TPVB with 0.375% ropivacaine (7 ml) for pacemaker implantation.
  • Cardiac arrest occurred during the procedure.
  • Resuscitation was performed using adrenaline and lipid emulsion.

Main Results:

  • The patient experienced cardiac arrest attributed to ropivacaine administration.
  • Plasma ropivacaine concentration was measured at 5.2 μg/ml.
  • Successful resuscitation was achieved with standard protocols.

Conclusions:

  • Inadvertent intravascular injection is a significant risk during TPVB.
  • Prompt recognition and management are vital for patient outcomes.
  • Lipid emulsion therapy can be life-saving in local anesthetic systemic toxicity (LAST).

Keywords:
Cardiac arrestChildLocal anesthetic systemic toxicityRopivacaineThoracic paravertebral block

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