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Probable Local Anesthetic Systemic Toxicity in a Postpartum Patient with Acute Fatty Liver of Pregnancy After a Transversus Abdominis Plane Block

Naidu, Ramana K. MD*; Richebe, Philippe MD, PhD

doi: 10.1097/ACC.0b013e3182973a2f
Case Reports: Case Report

We present the case of a 25-year-old woman with acute fatty liver of pregnancy, a rare mitochondrial disorder that manifests during pregnancy and has a significant mortality rate. Postoperative pain management is challenging for myriad reasons. With the increasing application of transversus abdominis plane blocks for postcesarean delivery analgesia, we describe the real and potential complications of this method of regional analgesia in patients with this disease.

From the *Department of Anesthesiology and Perioperative Care, Division of Pain Medicine, University of California–San Francisco, San Francisco, California; and Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington.

Accepted for publication April 4, 2013.

Funding: The authors received no funding for this submission.

The authors declare no conflicts of interest.

Address correspondence to Ramana K. Naidu, MD, Department of Anesthesiology and Pain Medicine, University of California–San Francisco, 2255 Post St., San Francisco, CA 94115. Address e-mail to

© 2013 International Anesthesia Research Society
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