Kim Ji Yeon, Park Beom Il, Heo Min Hee, Kim Kyoung Woo, Lee Sang-Il, Kim Kyung-Tae, Choe Won Joo, Park Jang Su, Kim Jun Hyun
Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
Anesth Pain Med (Seoul). 2022 Apr;17(2):228-234. doi: 10.17085/apm.21093. Epub 2021 Dec 28.
Local anesthetics systemic toxicity (LAST) is a grave complication of regional anesthesia that usually occurs immediately after local anesthetics injection. Here, we report on rare late-onset toxicity cases after supraclavicular brachial plexus blocks.
Two patients underwent surgery for radius fractures. We used lidocaine 100 mg and ropivacaine 150 mg for blocking and infused dexmedetomidine for intraoperative sedation. The 63-year-old male patient's blood pressure dropped to 87/60 mmHg after 3 h 15 min after blocking. Ventricular fibrillation occurred 10 min later. After five defibrillations, electrocardiography showed ventricular tachycardia that was normalized through one cardioversion. The 54-year-old female patient's heart rate decreased to 35 beats/min 2 h 30 min after blocking. Her vital signs returned to normal after administering atropine, ephedrine, epinephrine, and lipid emulsion.
Physicians should remember that LAST may occur long after local anesthetic injection and be aware of factors that may adversely affect the course of LAST.
局部麻醉药全身毒性反应（LAST）是区域麻醉的一种严重并发症，通常在注射局部麻醉药后立即发生。在此，我们报告锁骨上臂丛神经阻滞术后罕见的迟发性毒性反应病例。
两名患者因桡骨骨折接受手术。我们使用100毫克利多卡因和150毫克罗哌卡因进行阻滞，并输注右美托咪定用于术中镇静。63岁男性患者在阻滞后3小时15分钟血压降至87/60 mmHg。10分钟后发生室颤。经过5次除颤后，心电图显示室性心动过速，通过一次心脏复律恢复正常。54岁女性患者在阻滞后2小时30分钟心率降至35次/分钟。给予阿托品、麻黄碱、肾上腺素和脂质乳剂后，其生命体征恢复正常。
医生应牢记LAST可能在局部麻醉药注射后很长时间才发生，并应意识到可能对LAST病程产生不利影响的因素。
