Bupivacaine-induced Nicolau Syndrome during Spinal Anesthesia: A Rare Presentation of Two Cases

Abstract

Purpose: We present an embolia cutis medicamentosa (Nicolau syndrome) case in a patient who received a BUPIVACANE injection with spinal anesthesia. Summary: A pregnant woman who received a Bupivacaine injection in the OT developed a necrotic lesion at the Bupivacaine injection site on her lower back. Her chief complaints were oligohydramnios, deranged LFT, hypothyroidism, and Doppler changes. After 10 days of wound care involving topical therapy, certain medications, and frequent follow-up appointments, the patient’s wound was resolved. Conclusion: Nicolau syndrome developed in the lower back side of a patient following a parenteral injection of BUPIVACANE. A proper injection technique is recommended to reduce the risk of this idiopathic adverse effect.