Bupivacaine
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Bupivacaine Facial nerve palsy: case report
A 30-year-old woman developed transient facial nerve palsy following administration of bupivacaine as a local anaesthesia. The woman, who had recurrent episodes of pericoronitis, underwent left maxillary and bilateral mandibular wisdom teeth extraction under unspecified general anaesthetic. At the time of admission, she had been receiving unspecified contraceptive pills. She had recently completed a course of metronidazole. At the end of the tooth extraction procedure, she received local anaesthesia with 0.5% bupivacaine injection 10mL [5mL each site; route not stated]. During the recovery from the general anaesthesia, she experienced a generalised left-sided facial weakness with asymmetric facial expression and drooping of the lip. Additionally, she was found to have lagophthalmos (inability to close the left eye) with Bells phenomenon. Her left frontalis function was also absent. After ruling out other differential diagnoses, she was diagnosed with facial nerve palsy secondary to bupivacaine [time to reaction onset not stated]. Due to lagophthalmos, the ophthalmologist was consulted. The woman instructed to use a thick paraffin-based ointment to lubricate and protect the cornea. Additionally, the physician advised her to close the eyelids manually and to tape the lids closed horizontally at night. Her facial nerve palsy did not require hospitalisation, and therefore, she was discharged on the same day. However, clear instructions were given to seek advice if the facial function did not return by the next day. Further, her facial expression gradually improved. Within 5 hours following the procedure, her full facial nerve function including eyelid closure completely resolved. Jenyon T, et al. Transient facial nerve palsy following dental local anaesthesia. BMJ Case Reports 13: 234753, No. 9, 7 Sep 2020. Available from: URL: http:// doi.org/10.1136/bcr-2020-234753
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Reactions 21 Nov 2020 No. 1831
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