Abstract
Systemic toxicity arising from local anesthetic injection is a possible complication of stellate-ganglion block (SGB). While most patients are treated with benzodiazepine or vasoactive agents, this study reports the use of a lipid emulsion for this purpose. A 28-year-old man (height, 175 cm ; weight, 69 kg) underwent SGB for the treatment of paresthesia of the left mental area after a sagittal split ramus osteotomy. During the fifth block, 1% lidocaine was injected while performing a suction test after the injection of each milliliter. Positive blood aspiration was observed after the administration of 2 ml of lidocaine and was immediately followed by severe tonic‐clonic seizures. Subsequently, 10 l/min of oxygen and 20 mg of diazepam were administered through inhalational and intravenous routes, respectively. The continuation of the seizures as well as a high blood pressure (150/80 mmHg) and pulse rate (128 bpm) were observed. Thereafter, 100 ml of 20% soybean oil was administered by bolus injection. The seizure activity ceased approximately 2 minutes after the injection. Stabilization of the blood pressure (110/50 mmHg) and pulse rate (110 bpm) was achieved after 15 minutes, and no further adverse reactions were observed. We thought that soybean oil would prevent complications such as coma, respiratory depression, or cardiac arrest. Therefore, the administration of a lipid emulsion should be considered as a possible therapeutic option for systemic toxicity caused by local anesthetics.
