Tachycardia and convulsions induced by accidental intravascular ropivacaine injection during sciatic block

Ropivacaine, a recently introduced local anesthetic of the amide family (1), seems to show less toxicity than bupivacaine (2–4). Nevertheless, both neurologic and cardiovascular toxicities are possible. Six cases of ropivacaine-induced convulsions have previously been reported (5–10), of which three cases also showed cardiovascular toxicity. In three cases, total plasma concentrations were measured (Table 1). Table 1. Previously published cases of ropivacaine-induced convulsions. Kind of anesthesia Injected ropivacaine dose (mg) Cardiovascular toxicity Total plasma concentration/sampling time (min) Interscalene block (5) 150 – – Epidural anesthesia (6) 120 Sinus tachycardia – Epidural anesthesia (7) 20 Sinus tachycardia 5.1 µmol l−1 (1400 µg l−1 )/30 Sciatic block (8) 225 Severe cardiac dysrythmia 13.1 µmol l−1 (3600 µg l−1)/7 Interscalene block (9) 400 – 7.6 µmol l−1 (2090 µg l−1)/60 Epidural anesthesia (10) 275 – –