Status epilepticus following intrathecal administration of bupivacaine: a case report and literature review

Introduction: Bupivacaine is a commonly used local anesthetic in spinal anesthesia, known for its prolonged duration of action. Although rare, it can cause neurotoxic and cardiotoxic effects, including seizures, especially when administered incorrectly or in high doses. Case Presentation: A 49-year-old male with no significant medical history developed generalized tonic-clonic seizures and status epilepticus following spinal anesthesia with 2 mL of 0.5% intrathecal bupivacaine. Despite initial treatments, including benzodiazepines and antiepileptic drugs, the seizures persisted, requiring intensive care management. Laboratory results showed elevated creatine phosphokinase (CPK) and acute kidney injury, likely due to prolonged seizures. Clinical Discussion: The seizures are attributed to bupivacaine-induced neurotoxicity, potentially caused by rapid systemic absorption or cephalic diffusion of the drug. Bupivacaine’s action on voltage-gated sodium channels likely leads to neuronal hyperexcitability, resulting in seizures. Conclusion: This case highlights the rare but serious risk of status epilepticus following intrathecal bupivacaine administration. Prompt recognition and intervention are crucial to managing this complication and improving patient outcomes.