Acute toxic accident following lumbar plexus block with bupivacaine.

We report the case of a patient who experienced ventricular dysrhythmias an d seizure five minutes after the injection of 30 mL of 0.5% bupivacaine wit h 1:200,000 epinephrine, during a lumbar plexus block performed via the pos terior approach described by Winnie. The patient who underwent his total hi p arthroplasty was still anaesthetised and under controlled ventilation at the time of bupivacaine administration. Aspiration test performed before in jection was negative. Normal cardiac activity and stable haemodynamic condi tion were restored after one hour of resuscitation including 15 electric sh ocks and administration of epinephrine (40 mg) and clonidine (300 mu g) The patient was discharged without neurologic sequelae after four days in the ICU. (C) 2000 Editions scientifiques et medicales Elsevier SAS.