Nelson Mathew, Reens Alexandra, Reda Lara, Lee David
Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York.
J Emerg Med. 2018 Mar;54(3):e41-e43. doi: 10.1016/j.jemermed.2017.12.004. Epub 2017 Dec 30.
Interscalene brachial plexus blocks have been a routinely performed method of anesthesia for shoulder surgery that decreases the need for general anesthesia, length of stay, and recovery time. We describe a case of bupivacaine toxicity after an interscalene block.
The patient was a 66-year-old man who presented to our Emergency Department by emergency medical services from an ambulatory surgery center where he had undergone rotator cuff surgery, with bradycardia and hypotension. His symptoms began upon completion of the surgery in which he received interscalene nerve block with bupivacaine and lidocaine. He was given three doses of 0.5 mg atropine and one dose of 1 mg epinephrine for a heart rate of 40 beats/min without any improvement prior to arrival. His bradycardia was refractory to atropine. He was started on a dopamine drip and transferred to the coronary care unit. The timing of his symptoms, minutes after his regional nerve block, and his complete recovery with only supportive care, make the diagnosis of bupivacaine toxicity likely. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Despite the safety profile of local anesthetics, we must be aware of their potential side affects. Whereas most adverse reactions are secondary to misdirection of anesthetic or accidental vascular puncture, local anesthetic systemic toxicity (LAST) is the major cause of significant adverse events with regional anesthesia. As regional anesthesia becomes more common, emergency physicians must be more aware of the potential complications and be able to both diagnose and treat.
肌间沟臂丛神经阻滞一直是肩部手术常规采用的麻醉方法，可减少全身麻醉的需求、住院时间和恢复时间。我们描述了一例肌间沟阻滞术后布比卡因中毒的病例。
患者为一名66岁男性，由急救医疗服务从一家门诊手术中心送至我院急诊科，他在该中心接受了肩袖手术，出现心动过缓和低血压。他的症状在接受布比卡因和利多卡因肌间沟神经阻滞的手术后开始出现。在到达之前，他因心率40次/分钟接受了三次0.5毫克阿托品和一次1毫克肾上腺素治疗，但没有任何改善。他的心动过缓对阿托品无效。开始给予多巴胺滴注并转入冠心病监护病房。他症状出现的时间，在区域神经阻滞后几分钟，以及仅通过支持治疗就完全康复，使得布比卡因中毒的诊断很有可能。急诊医生为什么应该了解这个情况？：尽管局部麻醉药安全性良好，但我们必须意识到它们潜在的副作用。虽然大多数不良反应继发于麻醉药误注或意外血管穿刺，但局部麻醉药全身毒性（LAST）是区域麻醉严重不良事件的主要原因。随着区域麻醉越来越普遍，急诊医生必须更加了解潜在的并发症，并能够进行诊断和治疗。
