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Successful defibrillation immediately after the intravascular injection of ropivacaine

[Défibrillation réussie immédiatement après l’injection intravasculaire de ropivacaïne]

Mathieu Gielen, MD PhD^*, Robert Slappendel, MD PhD and Nigel Jack, MD

^* From the Departments of Anesthesiology, UMC St. Radboud; and
Sint Maartenskliniek, Nijmegen, The Netherlands.

Address correspondence to : Dr. Mathieu Gielen, Department of Anesthesiology, UMC St. Radboud, Postbus 9101, 6500 HB Nijmegen, The Netherlands. E-mail: mat.gielen{at}planet.nl

Purpose: To report successful resuscitation of ventricular fibrillation induced by accidental intravascular injection of ropivacaine.

Clinical features: A 15-yr-old healthy girl weighing 59 kg was scheduled for transposition of the tibial tuberosity under combined sciatic/three-in-one block. No premedication was given. In the induction room, an iv infusion was started, along with electrocardiogram monitoring, non-invasive blood-pressure measurement and pulse-oximetry. The sciatic nerve was found with the use of a nerve stimulator at the first attempt by the classical approach of Labat. Aspiration for blood was negative and the injection of ropivacaine 0.75% without epinephrine started. Convulsions, followed within seconds by ventricular fibrillation occurred at the end of the injection of 18 mL ropivacaine 0.75%. Oxygen was administered by face mask ventilation and immediate defibrillation was successful on the second attempt (2 x 200 joules). Within two minutes convulsions stopped and normal cardiac rhythm returned. Propofol and sufentanil were injected and a laryngeal mask inserted to start general anesthesia for surgery. Postoperatively no evidence of sciatic block could be demonstrated. The patient did not remember the event and was discharged the following day with no residual effects.

Conclusion: This case report shows that ventricular fibrillation after unintentional intravascular injection of ropivacaine can be treated successfully when one is prepared and cardiac life support measures are taken immediately.

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