Anesth Pain Med.  2010 Jul;5(3):222-226.

An unusual systemic toxicity of mepivacaine following axillary brachial plexus block or femoral/sciatic nerve block in patients with chronic renal failure and/or hypertension: A report of 2 cases

• Song SY
• Kim JH
• Heo MH

Abstract

There are few reports about the systemic toxicity of mepivacaine, which is widely used for regional nerve blocks, because of its short onset time and intermediate duration, during or after blockades. We report two cases. In the first, a 70 year-old female with chronic renal failure and hypertension was scheduled for arteriovenous fistula formation under axillary brachial plexus block using 30 ml of 1.5% mepivacaine. In the second, a 69 year-old female with hypertension who was scheduled for total knee replacement under femoral/sciatic nerve block with lateral femoral cutaneous nerve block using 45 ml of 1.5% mepivacaine. Both had an exaggerated hemodynamic response (of increased blood pressure and heart rate) with symptoms and signs of central nervous system excitation not evolving to convulsions, which was induced by mepivacaine during or soon after the blockades. Possible causes and mechanisms of the events are discussed based on the literature.

Keyword

Brachial plexus; Femoral nerve; Mepivacaine; Nerve block; Sciatic nerve; Toxicity

MeSH Terms

Arteriovenous Fistula
Arthroplasty, Replacement, Knee
Blood Pressure
Brachial Plexus
Central Nervous System
Female
Femoral Nerve
Heart
Hemodynamics
Humans
Hypertension
Kidney Failure, Chronic
Mepivacaine
Nerve Block
Sciatic Nerve
Seizures
Mepivacaine