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Lipid Emulsion as First Line Treatment in Ropivacain Induced Neurologic Toxicity

Evans Marc S and Fournier Roxane

A 67 year old female patient presented with new neurological deficits (clonic movements, progressive confusion, dysarthria) and hemodynamic instability (hypotension, sinus tachycardia) immediately after uneventful performance of a sciatic block. Prompt infusion of a 100 ml intralipid emulsion in addition to a single bolus of 100 mcg phenylephrine reversed these signs within less than five minutes. Subsequently she remained hemodynamically stable and her neurological status returned to baseline. In absence of further signs of toxicity, the continuous intralipid infusion was interrupted.