Abstract

Bupivacaine is a longer acting amide local anesthetic most commonly used for spinal and epidural anesthesia. A 55yr old male patient was scheduled for hernia surgery on 13/12/16. Following premedication with ondensetron 4mg IV, spinal anesthesia with 3.5ml of 0.5% Bupivacaine heavy (bupivacaine 5mg/ml and anhydrous dextrose 80mg/ml) and inj.Buprenorphine 75µg was administered in the L3-4 space with aseptic precautions. He also received inj.Amoxycillin and Clavulinic acid 1.2g during surgery. Two hours post-operatively, he complained of frontal headache- mild intensity, even in supine position which was treated with inj.Paracetamol 1g IV. There was no neck rigidity. After around an hour, he had nausea following which he had 3 bouts of vomiting. Four hours postoperatively, he developed rigors which gradually progressed to irritability. At the fifth hour postoperatively, he was disoriented and drowsy. A cerebrospinal fluid analysis revealed pH :7.5, glucose 18.1mg/100mL, proteins 494.7mg/100mL, a total leucocyte count of 4000/mm3 with 90% polymorphs and red blood cell count of 80/mm3 and gram stain- negative . The serum electrolytes were normal (Na 138.4 mEq/L and Sr. K 3.51 mEq/L). After the second dose of dexamethasone 8mg, he was shifted in the room and discharged. CSF culture revealed no growth. Seriousness of reaction was that intervention was required. Outcome of reaction was that patient recovered after 2 days. The reaction is certain according to WHO-UMC causality scale. Bupivacaine as a single agent should be screened for toxicity for individual factors like pH, osmolarity, the chemical vehicle, consequences of use of needles and catheters to place the drug and even patient’s preexisting pathological state. Aseptic meningitis is a rare and not very common complication of spinal anesthesia but if suspected postoperatively then early diagnosis and timely management should be commenced in order to avoid further complications.

Keywords: local anesthetic, WHO-UMC causality scale, bupivacaine, aseptic meningitis.