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Seizure after brachial plexus block — FRCA Final MCQ

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HardRegional AnaesthesiaSeizure after brachial plexus blockFRCA Final

A 37-year-old man is undergoing awake hand surgery with an infraclavicular block. Ten minutes after injection he becomes agitated, then has a tonic-clonic seizure. The injected mixture contained 30 ml of ropivacaine 0.75% and ultrasound spread was partly obscured by shadowing. What is the most likely cause of the complication?

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Correct answer: A — Systemic absorption or intravascular injection of ropivacaine

Seizure soon after a large-dose brachial plexus block is local anaesthetic systemic toxicity until proven otherwise. Vasovagal syncope causes bradycardia and hypotension rather than seizure. Subarachnoid spread is not anatomically plausible for an infraclavicular block. Management includes stopping injection, oxygenation, seizure control and lipid emulsion if severe features develop.

Reference: Association of Anaesthetists severe local anaesthetic toxicity guideline 2023