Lidocaine-induced CNS Toxicity - A Case Report

Lidocaine is the first local anesthetic of the amide type to be introduced to clinical practice. It is a versatile drug and in anesthesia, is the most commonly used local anesthetic because of its aptness of potency, rapid onset, moderate duration of action and topical activity. It is relatively safe and useful in many other clinical settings. Unfortunately, systemic intoxication and psychotic reaction associated with its use often occur because of its popularity and wider safety margin, for which guide in use is often ignored and overdose becomes commonplace. Moreover, due to its universality in use seldom reports have recently dealt with lidocaine, particularly regarding its toxic reaction. Here, we present a case of lidocaine intoxication occurring during circumcision for a reviewal of the problem. A healthy young male, weighing 65 kg, underwent circumcision for phimosis under penile block with 2% lidocaine which totaled 600 mg. Twenty minutes after injection the patient developed headache, tinnitus, visual and auditory disturbances. Muscle twitching over the mouth angles, trismus and rigidity of extremities were also noted. Later in the course he became restless, agitative, hallucinative, talkative, and verbose with repetitious words. The whole course of the disorder lasted about 5 h. It was believed that lidocaine-induced CNS intoxication, manifested by psychotic reaction broke out. Treatment with thiopental was not very impressive. Also, we took this opportunity to discuss and review the toxic reaction associated with the use of lidocaine, its risk factors, mechanism, treatment and prevention. The complicated associations of lidocaine-induced CNS toxic reaction with central control of behavior and the neurotransmitter systems (adrenergic, dopaminergic and serotonin) were also touched.

關鍵字

Anesthetics, local: lidocaine ； Poisoning, overdose: CNS toxicity ； Psychoses: substance-induced

並列摘要

利多卡因（lidocaine）是最先使用在臨床上的胺基酸胺基類局部麻醉劑。因為它的作用強度、迅速的起始作用、中等度的作用時間、和局部麻醉的特性，利多卡因仍然是多用途、最常用的局部麻醉劑。此外，利多卡因無論是在半身麻醉的應用、局部麻醉的應用、或是其他的用途，都是一種安全、多用處的藥物。不幸的是，全身性的毒性反應，甚至於精神性反應，也常常發生。只是文獻上很少報告，其主要原因是我們往往輕忽它們的存在。因此，提出這個病例個案討論，期望能提醒、警惕我們。病人是一個健康年輕的男性，來接受包皮過長的切除手術。採用的麻醉方式是陰莖神經阻斷術，使用的麻醉劑是2％利多卡因，總劑量600毫克。利多卡因注射後20分鐘，病人開始感到頭痛、頭昏、眼花、耳朵不舒服，慢慢的出現嘴角抽動、牙關緊閉、四肢僵硬抽搐的症狀。最後，病人變得多話伴隨重覆的字句、煩躁不安、躁動的行為、甚至出現類似幻聽的症狀。這些症狀持續了約5小時之久。我們認為這是一個利多卡因引起的中樞神經性毒性反應以精神性反應為表徵。我們探討了它的危險因子、作用機轉、預防和治療的方式。另外，我們也趁此機會，復習了利多卡因引起的中樞神經性毒性反應，和行為控制中樞、神經傳導物質系統（serotonin, noradrenaline, dopamine）之間複雜而多重的關係。

並列關鍵字

麻醉劑，局部：lidocaine ；中毒，過量：中樞神經中毒；精神病態：物質引發

國際替代計量

Lidocaine-induced CNS Toxicity - A Case Report

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