Lidocaine
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Central nervous system toxicity in the form of euphoria and slurred speech: case report A 48-year-old man developed central nervous system toxicity in the form of euphoria and slurred speech following the administration of lidocaine during erector spinae plane block (ESPB) procedure. The man presented to clinic for Herpes Zoster related pain in the left flank accompanied by a burning and tingling sensation (current presentation). His medical history was significant for a caudal block for the treatment of back pain due to spondylolytic spondylolisthesis at L5/S1 and an adductor canal block for the treatment of left knee pain with lidocaine. No side effects were noted during or after the procedures. Following the current presentation, ESPB was scheduled to treat his pain. During the procedure, he was injected 10mL of 1% lidocaine into the erector spinae plane followed by sodium chloride [saline]. Lidocaine was injected slowly at the rate of 1mL every 3 seconds at 5mL increments with a careful repetitive aspiration. However, 2 minutes after completion of the procedure, he began to laugh and inaccurately stated that he was feeling very good. As no other possible aetiologies were identified, lidocaine induced central nervous system toxicity was considered. His vital signs remained within the normal limits. Intubation and emergency kits were prepared, but no new neurological symptoms were noted apart from the slurred speech and euphoria. After 35 minutes, the neurological symptoms subsided completely. Significant reduction was also noted in his pain score. He reported the feeling as "I seemed to be drunk. It was the most pleasant and happy feeling I ever had". He was observed for 2 hours. After confirmation of no residual neurological symptoms, he was discharged. Lee JY, et al. A rare case of euphoria caused by lidocaine after an erector spinae plane block: A case report. Journal of Pain Research 13: 2329-2332, 2020. Available from: 803516044 URL: http://doi.org/10.2147/JPR.S271535
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Reactions 21 Nov 2020 No. 1831
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