ACCIDENTAL INTRAVENOUS INJECTION OF BUPIVACAINE: A COMPLICATION OF OBSTETRICAL EPIDURAL ANAESTHESIA: Case Report

摘要: SUMMARY A primigravid patient in labour had an epileptiform convulsion following the first "top- up" injection of bupivacaine 50 mg into epidural space. The fit was treated success- fully by artificial ventilation with oxygen and there were no subsequent ill effects mother. foetus born several hours later good condition. maternal venous plasma concentration found to have been 2.3 yug/ml during acute episode. An electroenceph alogram performed on after discharge from hospital reported as normal. 25-year-old primigravida admitted early a normal pregnancy. She previous medical history apart Fenton's operation for dyspareunia. Progress slow difficult assess because vaginismus. Diamorphine 10 given intra- muscularly did not provide satisfactory pain relief lumbar block requested. With left lateral position, space at interspace L3-4 located using saline-filled syringe attached Lee's modified Tuohy needle. Portex Skinner catheter, insertion, entered vein removed. When procedure repeated L2-3 blood catheter it advanced 2 cm test dose hydrochloride 5 minutes later, 0.5% solution without adrenaline, injected. Satisfactory analgesia achieved loss knee, ankle anal reflexes. Vaginal examination easy perform scalp e.c.g. electrode foetus. Ninety-five became distressed "top-up" given. No could be aspirated catheter. Following dose, bupi- vacaine 40 Immediately mild convulsion. air- way inserted administered inter- mittent positive pressure ventilation. lasted approximately 20 seconds shortly this spon- taneous respiration returned. remained pink 140/80 mm Hg. mother's pulse rate 72 beats/min foetal heart 140 beats/min. Consciousness returned time appeared rational. sample taken 3 onset estimation concentra- tion. removed opiate anal- gesia used remainder labour. At full dilatation cervix head occipito-posterior position. Under general anaesthesia die rotated occipito-anterior position baby delivered easily Neville Barnes forceps. Apgar score 1 minute 10.