Vol 6 | Issue 1 | January-April 2020 | page: 19-21 | Diego Tavoletti, Elisabetta Rosanò, Elisabetta Cerutti,
Author: Diego Tavoletti , Elisabetta Rosanò , Elisabetta Cerutti , Luca Pecora 
 Department of Emergency, Ospedali Riuniti Ancona, Marche Polytechnic University, Via Conca 71, 60126 Ancona, Italy.
 Department of Emergency, Ospedali Riuniti Ancona, Via Conca 71, 60126 Ancona, Italy.
Address of Correspondence
Dr. Diego Tavoletti,
Clinic of Anesthesia and Intensive Care Unit, Department of Emergency, Ospedali Riuniti Ancona, Marche Polytechnic University ,Via Conca 71, 60126 Ancona, Italy.
Combined femoral and sciatic nerve block with Levobupivacaine in Brugada syndrome patient: A case report
Introduction: Brugada syndrome is a rare arrhythmic disorder associated to ventricular fibrillation and sudden cardiac death. General recommendations in Brugada syndrome patient are focused on avoiding increases in vagal tone and precipitating agents such as electrolyte disorders, hypo/hyperthermia and drugs. Anesthetic management in Brugada syndrome patient has been described in many case reports, however it is still unknown which anesthesia is the safest. Local anesthetic may have a theoretical arrhythmogenic risk, but currently there is no clear evidence and their risk is still debated. Peripheral nerve block avoids autonomic nervous system changes that occur with other anesthetic techniques and it is associated to a lower level in the plasma concentration of the local anesthetic compared with neuraxial anesthesia.
Case Report: We report a case of a 38-year-old man patient with Brugada syndrome who underwent urgent orthopedic surgery which was managed with a combined femoral and sciatic nerve blocks using levobupivacaine without any complications.
Conclusions: Peripheral nerve block with levobupivacaine provided good analgesia, hemodynamic and cardiac stability in Brugada syndrome patient.
Keywords: Brugada syndrome, Anesthesia, Levobupivacaine, Peripheral nerve block, Regional anesthesia
1. Duque M, Santos L, Ribeiro S, Catré D. Anesthesia and Brugada syndrome: A 12-year case series. J Clin Anesth. 2017;36:168-73.
2. Carey SM, Hocking G. Brugada syndrome: a review of the implications for the anaesthetist. Anaesth Intensive Care. 2011;39:571-77.
3. Phillips N, Priestley M, Denniss AR, Uther JB. Brugada-type electrocardiographic pattern induced by epidural bupivacaine. Anesth Analg. 2003;97:264-67.
4. Oliván B, Arbeláez A, de Miguel M, Pelavski A. Diagnosis of Brugada’s syndrome after subarachnoid injection of prilocaine. Rev Esp Anestesiol Reanim. 2016;9356:278–79.
5. Kaneda Y, Fujita N, Ueda K, Saeki K, Sakano H, Sudo M, et al. Surgically treated primary lung cancer associated with Brugada syndrome: report of a case. Surg Today. 2001;31:817-19.
6. Fujiwara Y, Shibata Y, Kurokawa S, Satou Y, Komatsu T. Ventricular tachycardia in a patient with Brugada syndrome during general anesthesia combined with thoracic paravertebral block. Anesth Analg. 2006;102:1590-1.
7. Kloesel B, Ackerman MJ, Sprung J, Narr BJ, Weingarten TN. Anesthetic management of patients with Brugada syndrome: a case series and literature review. Can J Anaesth. 2011;58:824-36.
8. Kim JS, Park SY, Min SK, Kim JH, Lee SY, Moon BK. Anaesthesia in patients with Brugada syndrome. Acta Anaesthesiol Scand. 2004;48:1058-61.
9. Bang YS, Lee SY, Ko D, , Park J, Ahn S, Park C. Brugada syndrome patient undertaken brachial plexus block. Ewha Med J. 2017;40:164-7.
10. Vasques F, Di Gregorio G, and Behr AU. Is prevention better than cure? local anesthetics in Brugada syndrome. Regional Anesth Pain Med. 2015;40:395-6.
11. Chen Q, Venkatesan K, Cheong G. General and regional anaesthesia in Brugada Syndrome – a case report. Trends in Anaesthesia and Critical Care 2017.
12. Ferreira MN, Fontes S, Machado H. Interscalene plexus block and general anesthesia in Brugada syndrome. Saudi J Anaesth. 2019;13:371-3.
13. Dulu A, Pastores SM, McAleer E, Voigt L, Halpern NA. Brugada electrocardiographic pattern in a postoperative patient. Crit Care Med 2005;33:1634-7.
14. Burlacu CL, Buggy DJ. Update on local anesthetics: Focus on levobupivacaine. Ther Clin Risk Manag. 2008;4:381–92.
|How to Cite this Article: Tavoletti D, Rosanò E, Cerutti E, Pecora L | Combined femoral and sciatic nerve block with Levobupivacaine in Brugada syndrome patient: A case report | Journal of Anaesthesia and Critical Care Case Reports | Jan-April 2020; 6(1): 19-21.|