Central nervous system toxicity in a patient receiving continuous intrapleural bupivacaine

A patient developed signs of central nervous system (CNS) toxicity during treatment of postthoracotomy pain with a continuous intrapleural bupivacaine infusion. This incident occurred after the patient's chest tube was clamped, without any decrease in the bupivacaine infusion rate. This is the first reported case of CNS toxicity in a patient receiving a continuous intrapleural bupivacaine infusion. Possible etiologies of this complication are discussed, as are ways to avoid such a complication in the future.