Nicolau Syndrome, an Iatrogenic Drug Reaction Caused by Bupivacaine Injection as Spinal Anaesthesia: A Description of Two instances and Literature Review
Vishal Kumar *
Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh- 244001, India.
Pramod Kumar Manjhi
Department of Pharmacology, All India Institute of Medical Science, Patna, Bihar– 801507, India.
Amol Raj
Department of Materiovigilance Programme of India (MvPI), Indian Pharmacopoeia Commission (IPC), Ghaziabad, Uttar Pradesh, 201002, India.
*Author to whom correspondence should be addressed.
Abstract
An uncommon side effect of administering medications parenterally is Nicolau syndrome. Pain will first manifest, followed by edema and erythema, and finally, a necrotic plaque will be seen. An uncommon side effect of parenteral medication administration is Nicolau syndrome. It is characterized by the initial manifestation of pain, followed by edema, erythema, and ultimately the formation of a necrotic plaque. In this report, we present two exceptional cases of female patients who developed Nicolau syndrome after receiving a spinal anesthetic injection of bupivacaine. Their therapeutic regimen included the use of pentoxifylline, Omnacortil, cetirizine tablets, flucidine H cream, and Calasoft AF lotion, applied in a 1:1 combination for topical application.
Keywords: Nicolau syndrome, livedoid dermatitis, bupivacaine injection, Embolia cutis medicamentosa