Zusammenfassung
Eine junge Patientin erleidet während der Anlage einer axillären Plexusblockade einen generalisierten Krampfanfall. Die Mechanismen, im Wesentlichen die vermutlich intravasale Gabe, die zur Lokalanästhetikaintoxikation als Ursache für dieses Ereignis geführt haben, werden diskutiert.
Abstract
A young patient experienced a generalized seizure during the placement of an axillary plexus block. The mechanisms, essentially the presumed intravascular administration, which led to the local anesthetic toxicity as the cause of this event, are discussed. This case is an example of how visualization of the anatomy by ultrasound can give a false impression when certain details are not respected. It is assumed that the main mechanism in this case was venous compression by the ultrasound transducer.
Literatur
Braid DP, Scott DB (1965) The systemic absorption of local analgesic drugs. Br J Anaesth 37:394–404
Böhmer AB, Defosse J, Geldner G, Mertens E, Zwissler B, Wappler F (2012) Präoperative Risikoevaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen. Anaesthesist 61:407–419
Dernedde M, Furlan D, Verbesselt R, Gepts E, Boogaerts JG (2004) Grand mal convulsion after an accidental intravenous injection of ropivacaine. Anesth Analg 98:521–523
Dillane D, Finucane BT (2010) Local anesthetic systemic toxicity. Can J Anaesth 57:368–380
Fenten MGE, Schoenmakers KPW, Heesterbeek PJC, Scheffer GJ, Stienstra R (2015) Effect of local anesthetic concentration, dose and volume on the duration of single-injection ultrasound-guided axillary brachial plexus block with mepivacaine: a randomized controlled trial. BMC Anesthesiol 15:130
Forero CM, Forero CM, Gomez Lora CP, Bayegan D (2013) Undetected intravascular injection during an ultrasound-guided axillary block. Can J Anaesth 60:329–330
Gaurav K, Geeta C (2011) Ropivacaine: a review of its pharmacology and clinical use. Indian J Anaesth 55:104–110
Gitman M, Barrington MJ (2018) Local anesthetic systemic toxicity. Reg Anesth Pain Med 43:124–130
Hadzic A, Dewaele S, Gandhi K, Santos A (2009) Volume and dose of local anesthetic necessary to block the axillary brachial plexus using ultrasound guidance. Anesthesiology 111:8–9
Iwama H (2005) A case of normal ropivacaine concentration causing grand mal seizure after epidural injection. Eur J Anaesthesiol 22:322–323
Meier G (2013) Plexus Axillaris. In: Meier G, Büttner J (Hrsg) Atlas der peripheren Regionalanästhesie. Thieme, Berlin, S 131–135
Müller M, Litz RJ, Hüler M, Albrecht DM (2001) Grand mal convulsion and plasma concentrations after intravascular injection of ropivacaine for axillary brachial plexus blockade. Br J Anaesth 87:784–787
O’Donnell BD, Iohom G (2009) An estimation of the minimum effective anesthetic volume of 2 % lidocaine in ultrasound-guided axillary brachial plexus block. Anesthesiology 111:25–29
Robards C, Clendenen S, Greengrass R (2008) Intravascular injection during ultrasound-guided axillary block: negative aspiration can be misleading. Anesth Analg 107:1754–1755
Sites BD, Spence BC, Gallagher JD, Wiley CW, Bertrand ML, Blike GT (2007) Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia. Reg Anesth Pain Med 32:107–115
Sites BD, Taenzer AH, Herrick MD, Gilloon C, Antonakakis J, Richins J, Beach ML (2012) Incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms associated with 12’668 ultrasound-guided nerve blocks: an analysis from a prospective clinical registry. Reg Anesth Pain Med 37:478–482
Wank W, Büttner J, Maier KR, Emanuelson BM, Selander D (2002) Pharmacokinetics and efficacy of 40 ml ropivacaine 7.5 mg/ml (300 mg), for axillary brachial plexus block—an open pilot study. Eur J Drug Metab Pharmacokinet 27:53–59
Warnecke T, Schmitz J, Kerkhoff S, Hinkelbein J (2018) Anästhesie bei Patienten mit NBIA. Anaesthesist 67:871–877
Wiesmann T, Schubert AK, Volk T, Kubulus C, Zausig Y, Graf BM, Steinfeldt T (2020) Prävention & Therapie der systemischen Lokalanästhetika-Intoxikation (LAST) S1-Leitlinie. AWMF, online (AWMF-Registernr. 001–044)
Yang H‑J, Gil Y‑C, Jin J‑D, Cho H, Kim H, Lee H‑Y (2012) Novel findings of the anatomy and variations of the axillary vein and its tributaries. Clin Anat 25:893–902
Zetlaoui PJ, Labbe J‑P, Benhamou D (2008) Ultrasound guidance for axillary plexus block does not prevent intravascular injection. Anesthesiology 108:761
Zink W, Graf BM (2003) Toxikologie der Lokalanästhetika. Anaesthesist 52:1102–1123
Zink W, Graf BM (2007) Lokalanästhetikatoxizität – Relevanz empfohlener Maximaldosen? Anasth Intensivmed 48:182–205
Zink W, Graf BM (2008) The toxicity of local anesthetics: the place of ropivacaine and levobupivacaine. Curr Opin Anaesthesiol 21:645–650
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
T. Hillermann, K. Homburg, M. Rainer und U. Budde geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.
Additional information
QR-Code scannen & Beitrag online lesen
Rights and permissions
About this article
Cite this article
Hillermann, T., Homburg, K., Rainer, M. et al. Generalisierter Krampfanfall während der Anlage einer axillären Plexusblockade. Anaesthesist 71, 299–302 (2022). https://doi.org/10.1007/s00101-021-01055-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00101-021-01055-x