2026 SOAP Annual Meeting

Brugada syndrome

•An inherited disorder associated with malignant ventricular arrythmias and sudden cardiac death

•20-30% of patients have SCN5A Na channel mutation

•

Known drug triggers on BrugadaDrugs.org

•Avoid: bupivacaine, ergonovine, propofol infusion

•Preferable to Avoid: IV lidocaine, metoclopramide

Case

22 yo G2P1 patient with Brugada Syndrome scheduled for repeat CS

Relevant Hx:

•BMI 53, Type II DM, Gestational HTN

•Previous CS under spinal bupivacaine

•Neonatal seizure led to workup

•SCN5A mutation identified in patient

•Type I-like pattern on provocation testing, leading EP to strongly recommend avoiding bupivacaine

Intraoperative management

•Lidocaine CSE

•Spinal: 30mg lidocaine, 15mcg fentanyl and 100mcg morphine

•Epidural: total 15mL epidural 2% lidocaine with 1:200,000 epinephrine

Outcome:

•Brief episode of SVT post spinal, treated with IV labetalol and midazolam

•Remainder of course uneventful, discharged home POD3

Systematic Review

•Neuraxial anesthesia in patients with Brugada Syndrome

•13 case reports

•3 case series

•1 retrospective cohort

•71 neuraxial cases (46 obstetric)

•8 reported cases of IT bupivacaine

•Arrhythmias reported only for thoracic surgeries in 3 elderly men (age 56-77) with bupivacaine epidurals

VT, VF, provoked Brugada sign

Learning Points:

•Available literature is insufficient to support or refute recommendations to avoid bupivacaine.

•

•Key factors associated with risk: dose, duration of exposure, patient phenotype

•Alternatives available: Lidocaine CSE or neuraxial techniques with ropivacaine may be most suitable alternatives.

Brugada syndrome

•An inherited disorder associated with malignant ventricular arrythmias and sudden cardiac death

•20-30% of patients have SCN5A Na channel mutation

•

Known drug triggers on BrugadaDrugs.org

•Avoid: bupivacaine, ergonovine, propofol infusion

•Preferable to Avoid: IV lidocaine, metoclopramide

Case

22 yo G2P1 patient with Brugada Syndrome scheduled for repeat CS

Relevant Hx:

•BMI 53, Type II DM, Gestational HTN

•Previous CS under spinal bupivacaine

•Neonatal seizure led to workup

•SCN5A mutation identified in patient

•Type I-like pattern on provocation testing, leading EP to strongly recommend avoiding bupivacaine

Intraoperative management

•Lidocaine CSE

•Spinal: 30mg lidocaine, 15mcg fentanyl and 100mcg morphine

•Epidural: total 15mL epidural 2% lidocaine with 1:200,000 epinephrine

Outcome:

•Brief episode of SVT post spinal, treated with IV labetalol and midazolam

•Remainder of course uneventful, discharged home POD3

Systematic Review

•Neuraxial anesthesia in patients with Brugada Syndrome

•13 case reports

•3 case series

•1 retrospective cohort

•71 neuraxial cases (46 obstetric)

•8 reported cases of IT bupivacaine

•Arrhythmias reported only for thoracic surgeries in 3 elderly men (age 56-77) with bupivacaine epidurals

VT, VF, provoked Brugada sign

Learning Points:

•Available literature is insufficient to support or refute recommendations to avoid bupivacaine.

•

•Key factors associated with risk: dose, duration of exposure, patient phenotype

•Alternatives available: Lidocaine CSE or neuraxial techniques with ropivacaine may be most suitable alternatives.

2026 SOAP Annual Meeting

Neuraxial Anesthesia for Cesarean Delivery in a Patient with Brugada Syndrome: A Case Report and Systematic Review

Poster Presenter

Authors

Affiliations

Part of Topic

2026 SOAP Annual Meeting

Neuraxial Anesthesia for Cesarean Delivery in a Patient with Brugada Syndrome: A Case Report and Systematic Review

Poster Presenter

Authors

Affiliations

Part of Topic