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bupivacaine

A local anesthetic of the amide group. It is a racemic mixture of 2 stereoisomers. In nerve blocks, it is injected around a nerve that supplies the area, or into the spinal canal's epidural space. It is available mixed with a small amount of epinephrine to increase the duration of its action. It typically begins working within 15 minutes and lasts for 2-8 hours. (Side effects) • sleepiness • muscle twitching • changes in vision • tinnitus • hypotension • arrhythmia (Contraindications) • hypersensitivity reactions to bupivacaine or amino-amide anesthetics • obstetrical paracervical blocks and intravenous regional anesthesia (Bier block): Due to potential risk of tourniquet failure and systemic absorption of the drug and subsequent cardiac arrest. • 0.75% formulation (high concentration) in epidural anesthesia during labor: Due to increased length of labor and refractory cardiac arrest. (Comparisons with ropivacaine) • Injection into the joint: It can cause problems with the cartilage. A defect cell structure and increased number of dead cells may be observed under a microscope after injection of lidocaine or bupivacaine, but not ropivacaine. Ropivacaine seems to be a local anesthetic with the lowest toxicity on chondrocytes in joints. • Injection into the epidural space around the spinal cord (epidural analgesia, epidural freezing): Ropivacaine is a levorotatory propyl homologue of bupivacaine, because of its structural features and physicochemical properties. It is less toxic to nervous system and heart but lower potency than bupivacaine. Epidural administration of amide local anesthetics in combination with opioids such as fentanyl is widely used for pain relief in labor because of the dose minimizing and side effects reducing benefits. Bupivacaine is the most widely used long-acting amide local anesthetic.