Ropivacaine toxicity after surgical wound local infiltration in a patient with renal failure
1Department of Anaesthesiology, Pain and Palliative Care, «Laiko» General Hospital of Athens, Athens, Greece
DOI: 10.22514/sv.2021.162 Vol.17,Issue S1,September 2021 pp.17-17
Submitted: 26 August 2021 Accepted: 06 September 2021
Published: 15 September 2021
*Corresponding Author(s): Eleni Papaioannou E-mail: firstname.lastname@example.org
Aim of study: is to present case of ropivacaine toxicity after surgical wound infiltration.
Case report: Female 49-year-old patient, with chronic renal failure, underwent kidney transplantation from living donor. Her medical history, revealed hypertension. No known allergies were mentioned. She had had laparoscopic cholecystectomy and placement of peritoneal catheter. She also had dental surgeries under local anaesthetic without any complications. Preanaesthetic examination was normal, apart from the expected.
Patient was intraoperatively haemodynamically stable. During reperfusion, there was no remarkable haemodynamic instability (Blood Pressure (BP): 140/70 mmHg, Heart rate (HR): 62 bpm). Before closure, surgical wound was infiltrated with ropivacaine, 0.375% 20 mL. 18 minutes later, BP and cardiac output-CO were abruptly decreased (mean BP – MBP <55 mmHg and CO dropped from 7.1 to 2.5 L/min). H1, H2 receptor antagonists and crystalloids were administered iv, and noradrenaline infusion maintained MBP between 70–80 mmHg. Cardiac ultrasound was normal and troponin count was negative. Surgical wound was reopened for investigation, which did not reveal haemorrhage. One hour postoperatively, patient was stabilized, extubated, and was transferred to ICU for observation, without any sympathokinetic drugs’ infusion. Post-awakening, she complained about tongue numbness. Two months later, as renal function was normal, she was scheduled for peritoneal catheter removal. Ropivacaine 0.357% 10 mL was administered for wound infiltration. Milder decrease in BP and CO 20 min later, was immediately managed with noradrenaline iv infusion. Post-extubation, the patient reported metallic taste that raised furthermore initial suspicion of ropivacaine toxicity.
Conclusion: Ropivacaine wound infiltration has been probably the reason of decrease in MBP and CO (local anaesthetic toxicity) in this case. International literature review was not conclusive, apart from cases of prolonged ropivacaine duration, in renal failure patients [1, 2]. Further observation of similar cases is necessary to confirm ropivacaine toxicity after wound local infiltration.
Chara Savva,Efthimia Kalliontzi,Eleni Papaioannou,Dimitrios Karousos,Aikaterini Liosi,Despoina Danassi,Aikaterini Lampadariou. Ropivacaine toxicity after surgical wound local infiltration in a patient with renal failure. Signa Vitae. 2021. 17(S1);17-17.
 Jokinen MJ. The pharmacokinetics of ropivacaine in hepatic and renal insufficiency. Best Practice & Research Clinical Anaesthesiology. 2005; 19: 269–274.
 Pere PJ, Ekstrand A, Salonen M, Honkanen E, Sjövall J, Henriksson J, et al. Pharmacokinetics of ropivacaine in patients with chronic renal failure. British Journal of Anaesthesia. 2011; 106: 512–521.
Vol., Issue , Invalid dateTable of contents
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.