Ropivacaine tonic-clonic seizures

A 52-year-old woman received an axillary plexus block with 20 ml of 1% ropivacaine, clonidine 70 micrograms, and 15 ml of 1% mepivacaine with 1 400 000 adrenaline. Generalized tonic-clonic seizure activity developed, even though careful incremental aspiration was performed. She was still comatose 90 minutes later, but this was reversed by intravenous naloxone. 

A ropivacaine-induced seizure occurred in a 23-year-old woman undergoing postpartum tubal ligation. An epidural that had been inserted for labor the evening before the procedure was used to give ropivacaine 120 mg in increments over 11 minutes. She complained of nervousness and within a few seconds had a generalized tonic-clonic seizure and a sinus tachycardia of 120/minute. 

An 18-year-old man with a history of childhood febrile convulsions received a combined axil-lary/interscalene brachial plexus block with two doses of ropivacaine 150 mg 15 minutes apart, and 2 minutes after the second dose developed generalized tonic-clonic seizure, which were successfully treated with oxygen, ventilation, and intravenous midazolam. The arterial plasma concentration ropivacaine at the time of the convulsions was only 2.1 mg/1. 

The adverse effects of ropivacaine and bupivacaine have been compared in 104 patients who received 30 ml of either 0.75% ropivacaine or 0.5% bupivacaine for subclavian perivascular brachial plexus block (48). There were similar incidences of nausea (33 and 28%), vomiting (8 and 14%), and Horner s syndrome (8 and 6%), and one patient who received bupivacaine developed a tonic-clonic generalized seizure 8 minutes after injection, suggestive of systemic toxicity. 

A 74-year-old man was to receive a combined sciatic nerve and psoas compartment block for a total hip arthroplasty the classic Labat s approach was used and 30 ml of 0.75% ropivacaine was injected over 1.5 minutes, after which he suddenly became unresponsive and developed tonic-clonic movements. Propofol was administered and the seizure resolved, but he developed sinus bradycardia with progressive lengthening of the QRS interval, which converted to nodal bradycardia. A ventricular escape rhythm at 20/minute with T wave inversion was treated with ephedrine 10 mg and adrenahne 0.1 mg, resulting in supraventricular tachycardia with transient atrial fibrillation. 

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