Volume 1 | Issue 2 | 1 of 3 Anesth Pain Res, 2017 Chemical Meningitis Following Spinal Analgesia with Levobupivacaine in Labor and Delivery: A Case Report 1 Faculty of Medicine, University of Rijeka, Croatia, Brace Branchetta 20, 51000 Rijeka, Croatia. 2 Department of Anaesthesia, Resuscitation and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Croatia, Brace Branchetta 20, 51000 Rijeka, Croatia. 3 Department of Neurology, Faculty of Medicine, University of Rijeka, Croatia, Brace Branchetta 20, 51000 Rijeka, Croatia. * Correspondence: Vlatka Sotošek tokmadžić, MD, PhD, Department of Anaesthesia, Resuscitation and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia, Tel: +38551651182; E-mail: vlatkast@medri.uniri.hr. Received: 14 October 2017; Accepted: 05 November 2017 Anamarija Predrijevac 1 , Alan Šustić 2 , Igor Antončić 3 , Siniša Dunatov 3 , Željko Župan 2 , Janja Kuharić 2 , Boban Dangubić 2 and Vlatka Sotošek Tokmadžić 2* Anesthesia & Pain Research ABSTRACT Chemical meningitis is a very rare but potentially devastating complication of spinal anaesthesia and analgesia. It can be provoked by intrathecal application of substances, such as local anaesthetics, or may occur as a result of the anaesthesia technique used. We describe, until now published, a case of 20-year-old primipara who received spinal analgesia with levobupivacaine for labor and delivery and developed generalized epileptic seizures and high fever. Laboratory tests showed an increased white blood cell count, elevated neutrophil granulocytes, and elevated C-reactive protein; the cerebrospinal fuid (CSF) analysis showed increased levels of proteins, lactate, leukocytes, and erythrocytes. A brain computed tomography (CT) and CT angiography scan did not reveal any pathological alteration. Microbiological analysis of CSF and blood cultures did not show any pathogen growth, and the patient was treated with antibiotics and corticosteroids. The patient later fully recovered and was discharged from the hospital. Case Report Citation: Predrijevac A, Šustić A, Antončić I, et al. Chemical Meningitis Following Spinal Analgesia with Levobupivacaine in Labor and Delivery: A Case Report. Anesth Pain Res. 2017; 1(1): 1-3. Keywords Levobupivacaine, Meningitis, Spinal analgesia, Status epilepticus. Introduction Spinal anaesthesia is one of the most reliable and versatile techniques available for providing anaesthesia and analgesia for labor and delivery. Although it has been used since the 1800s, its frequency of use decreased due to complications and the invention of the epidural technique. It became popular again with the development of newer, beveled needles. Spinal anaesthesia has many advantages, including extremely rapid onset of pain relief and the ability to retain motor control, but it is not free of side efects [1,2]. The most common side efects of spinal analgesia are hypotension and post-dural puncture headache [3]. These efects are usually mild, well tolerated, and transient [4]. More serious side efects, such as meningitis or seizures, are rare but potentially fatal. When meningitis, either chemical or bacterial, or epilepsy occurs, they must be treated without delay. We describe, in English literature until now unpublished, a case of chemical meningitis following spinal analgesia with levobupivacaine. Case Report A 20-year-old primipara at 39 weeks of pregnancy received spinal analgesia for labor and delivery. The technique and possible complications of spinal analgesia were explained to her, and she signed the informed consent form. The primipara was in a sitting position. An aseptic washing solution containing iodine (Antiseptica, Pulheim, Germany) was applied, and the excess solution was removed. Spinal anaesthesia was performed at the L2- to-L3 level using an atraumatic 26-gauge spinal needle (B Braun, Melsungen, Germany). When the spinal space was detected, 1.5 mL of 0.5% levobupivacaine (Fressenius Kabi, Bad Homrung, Germany) and 2.5 μg of sufentanil (Renaudin, Itxassou, France) were applied intrathecally. Within fve minutes, the patient felt pain relief and in forty minutes, she delivered a healthy baby boy. The next day she began to complain of a headache, neck and shoulder