Ropivacaine:An Unusual Cause of Neuroleptic Malignant-Like Syndrome

Miguel Santos; Sheila Arroja; Ana Luisa Antunes; Jose Mariz; Jorge Teixeira

doi:10.12890/2021_002971

Ropivacaine:An Unusual Cause of Neuroleptic Malignant-Like Syndrome

Eur J Case Rep Intern Med. 2021 Nov 8;8(11):002971. doi: 10.12890/2021_002971. eCollection 2021.

Authors

Miguel Santos¹, Sheila Arroja², Ana Luisa Antunes², Jose Mariz², Jorge Teixeira²

Affiliations

¹ Serviço de Medicina Interna, Centro Hospitalar de Leiria, Leiria, Portugal.
² Serviço de Urgência Geral, Hospital de Braga, Braga, Portugal.

Abstract

Ropivacaine is commonly used for post-operative pain management. We describe a case of neuroleptic malignant-like syndrome in a woman administered ropivacaine delivered using a drug infusion balloon. The presenting symptoms were confusion, agitation and fever. Blood analysis showed elevated C-reactive protein, leucocytosis and increased creatine phosphokinase. As intoxication was suspected, ropivacaine was suspended and the patient gradually improved. Possible leakage of ropivacaine into the intrathecal space may have resulted in central nervous system toxicity.

Learning points: It is important to be aware of the secondary effects of common drugs.The differential diagnosis should always include side effects and drug interactions.Intoxication can lead to poor outcomes, so early recognition is key.

Keywords: Ropivacaine; intoxication; neuroleptic malignant syndrome; secondary effects.