Bupivacaine-induced myocardial depression and pulmonary edema: A case report

Central nervous system and cardiovascular toxicity are well-known side effe cts of bupivacaine. We report a case of bupivacaine-induced myocardial depr ession and cardiogenic pulmonary edema. A previously healthy woman develope d soon after bupivacaine epidural injection of 5 mL 0.5% (25 mg) cardiogeni c shock complicated with pulmonary edema. There were pronounced rales on au scultation with a butterfly sign on chest radiograph. A cardiac ultrasound showed reduced myocardial contractility, diffuse hypokinesia, left ventricu lar ejection fraction (LVEF) 25%, mitral and pulmonary insufficiency. Right heart catheterization showed increased pulmonary artery wedge pressure (34 mm Hg) and a pulmonary artery pressure of 48 over 33 mm Hg. These findings suggest myocardial depression owing to bupivacaine sodium channel blocking of myocardial nerve and tissue and subsequent reduction of myocardial cont ractility. The patient completely recovered with normalization of clinical, roentenographic, ultrasound, and hemodynamic findings and discharged 10 da ys later in good condition.