2017 Volume 37 Issue 4 Pages 427-432
Postoperative drug-induced liver injury is a rare but serious perioperative complication, but identification of the responsible agent among numerous drugs is usually difficult. Here we describe a case of possible ropivacaine-induced liver injury. A 45-year-old woman with severe dysmenorrhea underwent total hysterectomy under general anesthesia with transversus abdominis plane block using ropivacaine. Her past history and laboratory data were unremarkable with the exception that she was receiving prednisolone for Behçet’s disease. Surgery was completed uneventfully with no remarkable hemodynamic changes. A notable increase of serum AST/ALT as well as prolongation of prothrombin time was detected on the day of surgery, with no abnormal findings in the liver examined by ultrasonography or laboratory data indicating virus infection. All medications except fentanyl were discontinued based on a diagnosis of drug-induced liver injury. Laboratory data recovered to the normal ranges within three weeks after surgery. Ropivacaine had a positive response in a drug-induced lymphocyte stimulation test and would have been responsible for the liver injury.
