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Bupivacaine toxicity

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https://www.readbyqxmd.com/read/27872765/cardiac-arrest-after-local-anaesthetic-toxicity-in-a-paediatric-patient
#1
Liana Maria Torres de Araújo Azi, Diego Grimaldi Figueroa, Ana Amélia Souza Simas
We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27833486/a-comparative-study-of-dexmedetomidine-and-fentanyl-as-adjuvants-to-levobupivacaine-for-caudal-analgesia-in-children-undergoing-lower-limb-orthopedic-surgery
#2
S M Elfawal, W A Abdelaal, M R Hosny
BACKGROUND: Levobupivacaine is an effective local anesthetic agent with less systemic toxicity than racemic bupivacaine, but it has short postoperative analgesic duration. Dexmedetomidine and fentanyl are promising adjuncts to provide excellent and prolonged postoperative caudal analgesia. This study compared the effects of caudal levobupivacaine plus dexmedetomidine and levobupivacaine plus fentanyl for postoperative analgesia and sedation in children undergoing lower limb orthopedic surgery...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27815173/stable-gastric-pentadecapeptide-bpc-157-and-bupivacaine
#3
Gordana Zivanovic-Posilovic, Diana Balenovic, Ivan Barisic, Dean Strinic, Vasilije Stambolija, Mario Udovicic, Sandra Uzun, Domagoj Drmic, Josipa Vlainic, Martina Lovric Bencic, Aleksandra Sindic, Sven Seiwerth, Predrag Sikiric
Bupivacaine toxicity following accidental overdose still lacks therapeutic solution. However, there are major arguments for testing BPC 157 against bupivacaine toxicity in vivo in rats, in particular, and then finally, in vitro. These are: the lack of any known BPC 157 toxicity, a lifesaving effect via the mitigation of arrhythmias in rats underwent hyperkalemia or digitalis toxicity, the elimination of hyperkalemia and arrhythmias in rats underwent succinylcholine toxicity and finally, the reduction of potassium-induced depolarization in vitro (in HEK293 cells) in severe hyperkalemia...
December 15, 2016: European Journal of Pharmacology
https://www.readbyqxmd.com/read/27790556/efficacy-of-sciatic-nerve-block-for-pain-management-in-below-knee-orthopaedic-surgery
#4
Subhadra Arun Sinha, Sandeep Champalal Mutha, Deepak Sadashiv Phalgune
INTRODUCTION: Perioperative pain management is an integral part of anaesthesia and patients are most satisfied if there is minimal or no pain after surgery. Sciatic nerve block provides postoperative pain relief after below knee surgery and knee surgery. Many studies with different approaches for sciatic nerve block have been conducted to demonstrate the efficacy of sciatic nerve block with different local anaesthetic drugs over the past decade. AIM: To study the efficacy of single-shot sciatic nerve block for postoperative pain management in below knee orthopaedic surgery...
September 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27778324/intraneural-injection-of-a-test-dose-of-local-anesthetic-in-peripheral-nerves-does-it-induce-histological-changes-in-nerve-tissue
#5
T Wiesmann, T Steinfeldt, M Exner, W Nimphius, J De Andres, H Wulf, U Schwemmer
BACKGROUND & OBJECTIVES: Most anesthesiologists use the injection of a test dose of local anesthetic in order to evaluate the final needle tip position. Thus, the intraneural injection of a full dose can be avoided. The aim of this study was to analyze whether an intraneural injection of a test dose of bupivacaine could trigger histological changes. METHODS: Intraneural injections under direct vision were performed in 40 brachial plexus nerves in seven anesthetized pigs...
October 25, 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27746542/a-randomized-controlled-study-between-fentanyl-and-butorphanol-with-low-dose-intrathecal-bupivacaine-to-facilitate-early-postoperative-ambulation-in-urological-procedures
#6
Arvind Kumar, Ritesh Kumar, Vinod Kumar Verma, Chandrakant Prasad, Rajesh Kumar, Shashi Kant, Gunjan Kumar, Neha Singh, Rupam Kumari
INTRODUCTION: Opioids are widely used in conjunction with local anesthetics as they permit the use of lower dose of local anesthetics while providing adequate anesthesia and analgesia. It both provides adequate anesthesia as well as lower drug toxicity neuraxial administration of opioids in conjunction with local anesthetics improves the quality of intraoperative analgesia and prolongs the duration of postoperative analgesia. Bupivacaine is the most commonly used drug for subarachnoid block due to its lesser side effects...
September 2016: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/27738501/lipid-emulsion-inhibits-vasodilation-induced-by-a-toxic-dose-of-bupivacaine-by-suppressing-bupivacaine-induced-pkc-and-cpi-17-dephosphorylation-but-has-no-effect-on-vasodilation-induced-by-a-toxic-dose-of-mepivacaine
#7
Hyunhoo Cho, Seong Ho Ok, Seong Chun Kwon, Soo Hee Lee, Jiseok Baik, Sebin Kang, Jiah Oh, Ju-Tae Sohn
BACKGROUND: The goal of this in vitro study was to investigate the effect of lipid emulsion on vasodilation caused by toxic doses of bupivacaine and mepivacaine during contraction induced by a protein kinase C (PKC) activator, phorbol 12,13-dibutyrate (PDBu), in an isolated endothelium-denuded rat aorta. METHODS: The effects of lipid emulsion on the dose-response curves induced by bupivacaine or mepivacaine in an isolated aorta precontracted with PDBu were assessed...
October 2016: Korean Journal of Pain
https://www.readbyqxmd.com/read/27687316/-effect-of-equipotent-doses-of-bupivacaine-and-ropivacaine-in-high-fat-diet-fed-neonatal-rodent-model
#8
Ying-Dong Lian, Zong-Xiang Chen, Kang-Ru Zhu, Shu-Yin Sun, Li-Ping Zhu
OBJECTIVES: The increase in the prevalence of obesity presents a significant health and economic problem. Obesity has been reported to be a major contributor to variety of chronic diseases. Childhood obesity has been rising over the past decades leading to various complications in health. Millions of infants and children undergo surgery every year on various health grounds. The present investigation was undertaken to evaluate the effect of spinal anesthesia of equipotent doses of ropivacaine and bupivacaine on over-weight neonatal rats...
September 26, 2016: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/27608281/evidence-based-recommendations-on-the-use-of-intravenous-lipid-emulsion-therapy-in-poisoning
#9
Sophie Gosselin, Lotte C G Hoegberg, Robert S Hoffman, Andis Graudins, Christine M Stork, Simon H L Thomas, Samuel J Stellpflug, Bryan D Hayes, Michael Levine, Martin Morris, Andrea Nesbitt-Miller, Alexis F Turgeon, Benoit Bailey, Diane P Calello, Ryan Chuang, Theodore C Bania, Bruno Mégarbane, Ashish Bhalla, Valéry Lavergne
BACKGROUND: Although intravenous lipid emulsion (ILE) was first used to treat life-threatening local anesthetic (LA) toxicity, its use has expanded to include both non-local anesthetic (non-LA) poisoning and less severe manifestations of toxicity. A collaborative workgroup appraised the literature and provides evidence-based recommendations for the use of ILE in poisoning. METHODS: Following a systematic review of the literature, data were summarized in four publications: LA and non-LA poisoning efficacy, adverse effects, and analytical interferences...
September 8, 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27430990/absorption-of-bupivacaine-after-administration-of-a-lozenge-as-topical-treatment-for-pain-from-oral-mucositis
#10
Stine Mogensen, Eva Sverrisdóttir, Kolbrún Sveinsdóttir, Charlotte Treldal, Kenneth Jensen, Anders Bonde Jensen, Claus Andrup Kristensen, Jette Jacobsen, Mads Kreilgaard, Janne Petersen, Ove Andersen
The aim was to investigate systemic exposure after administration of a novel bupivacaine lozenge in healthy individuals with normal mucosa and in head and neck cancer (HNC) patients with oral mucositis. A lozenge containing 5 mg, 10 mg, 25 mg and 50mg bupivacaine, respectively, was administered as single dose to 10 healthy invididuals and lozenge containing 25 mg bupivacaine was administered as single dose to 10 HNC patients with oral mucositis and as multiple doses to 5 HNC patients. Blood samples were collected for 6 hr from the healthy individuals and 3 hr from the HNC patients, respectively, after administration...
July 19, 2016: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/27347237/time-to-analgesia-onset-and-pharmacokinetics-after-separate-and-combined-administration-of-liposome-bupivacaine-and-bupivacaine-hcl-considerations-for-clinicians
#11
Jeffrey Gadsden, William J Long
BACKGROUND: Liposome bupivacaine is a prolonged-release bupivacaine formulation indicated for single-dose administration into the surgical site to produce postsurgical analgesia. METHODS: An overview of time to onset of analgesia observed with liposome bupivacaine in human studies is provided, as well as a summary of data from pharmacokinetic studies including those that assessed pharmacokinetics after separate versus coadministration of liposome bupivacaine and bupivacaine HCl...
2016: Open Orthopaedics Journal
https://www.readbyqxmd.com/read/27342601/new-updates-pertaining-to-drug-delivery-of-local-anesthetics-in-particular-bupivacaine-using-lipid-nanoparticles
#12
REVIEW
Siavash Beiranvand, Ali Eatemadi, Arash Karimi
Lipid nanoparticles (liposomes) were first described in 1965, and several work have led to development of important technical advances like triggered release liposomes and drug-loaded liposomes. These advances have led to numerous clinical trials in such diverse areas such as the delivery of anti-cancer, antifungal, and antibiotic drugs; the delivery of gene medicines; and most importantly the delivery of anesthesia drugs. Quite a number of liposomes are on the market, and many more are still in developmental stage...
December 2016: Nanoscale Research Letters
https://www.readbyqxmd.com/read/27310901/institutional-policy-changes-to-prevent-cardiac-toxicity-associated-with-bupivacaine-penile-blockade-in-infants
#13
Richard N Yu, Constance S Houck, Alfonso Casta, Richard H Blum
Dorsal penile nerve block is a widely used method of analgesia for infants undergoing penile surgery. Because of its potency, extended duration of action, and lack of vasoconstriction, bupivacaine remains the most commonly used local anesthetic. Rapid systemic absorption of bupivacaine, however, has been associated with profound central nervous system and cardiovascular side effects, including cardiac arrest. As determined by retrospective medical record analysis, the incidence of complications associated with dorsal penile blockade in our institution was 0...
August 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27302637/lipid-rescue-for-treatment-of-delayed-systemic-ropivacaine-toxicity-from-a-continuous-thoracic-paravertebral-block
#14
Trylon Mathew Tsang, Alfin Taddeo Okullo, Jeremy Field, Patrick Mamo
A 66-year-old man underwent a left minithoracotomy for pleural biopsies and thoracentesis. A left T3 paravertebral catheter was placed prior to induction of general anaesthesia, and a total of 20 mL of bupivacaine 0.25% administered. Postoperatively, ropivacaine 0.2% infusion was commenced at 10 mL/hour. Thirty-seven hours after the initial block, the patient developed convulsions without loss of consciousness. The ropivacaine infusion rate was unchanged and no further boluses had been given. He reported of perioral tingling, a burning sensation in his legs and penis and agitation...
2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27290962/bupivacaine-drug-induced-liver-injury-a-case-series-and-brief-review-of-the-literature
#15
Preethi Chintamaneni, Heather L Stevenson, Shahid M Malik
Bupivacaine is an established and efficacious anesthetic that has become increasingly popular in postoperative pain management. However, there is limited literature regarding the potential for bupivacaine-induced delayed liver toxicity. Describe cholestasis as a potential adverse reaction of bupivacaine infusion into a surgical wound. Retrospective review of patients' medical records. We report the cases of 3 patients with new onset of cholestatic injury after receiving bupivacaine infusion for postoperative herniorrhaphy pain management...
August 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27281728/giving-priority-to-lipid-administration-can-reduce-lung-injury-caused-by-epinephrine-in-bupivacaine-induced-cardiac-depression
#16
Mengxu Luo, Xia Yun, Chaoxing Chen, Nana Bao, Xiaona Feng, Linmin Pan, Zhousheng Jin, Cong Wu, Xianqin Wang, Thomas J Papadimos, Xuzhong Xu
BACKGROUND AND OBJECTIVES: Epinephrine is usually administered in concert with a lipid emulsion during local anesthetic toxicity. However, the timing and role of epinephrine administration in combination with a lipid emulsion remain unclear. Specifically, the temporal association of epinephrine and lipid emulsion administration with related changes in pulmonary vascular pressures that may lead to pulmonary edema and hemorrhage needs to be determined. METHODS: This study consisted of 2 parts, experiments A and B...
July 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27224931/the-effect-of-lipid-emulsion-on-pharmacokinetics-of-bupivacaine-in-rats-long-chain-triglyceride-versus-long-and-medium-chain-triglyceride
#17
Wan Tang, Quanguang Wang, Kejian Shi, Jiaojiao Dong, Shengxian Lin, Shishi Zhao, Cong Wu, Yun Xia, Thomas J Papadimos, Xuzhong Xu
BACKGROUND: Lipid infusions have been proposed to treat local anesthetic-induced cardiac toxicity. This study compared the effects of long-chain triglyceride (LCT) emulsions with those of long- and medium-chain triglyceride (LCT/MCT) emulsions on the pharmacokinetics of bupivacaine in a rat model. METHODS: After administration of intravenous infusion of bupivacaine at 2 mg·kg·min for 5 minutes in Sprague-Dawley (SD) rats, either Intralipid 20%, an LCT emulsion (LCT group, n = 6), or Lipovenoes 20%, an LCT/MCT emulsion (LCT/MCT group, n = 6), was infused at 2mg·kg·min for 5 minutes...
May 24, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27222493/the-effects-of-intravenous-lipid-emulsion-on-hemodynamic-recovery-and-myocardial-cell-mitochondrial-function-after-bupivacaine-toxicity-in-anesthetized-pigs
#18
J A Heinonen, A A Schramko, M B Skrifvars, E Litonius, J T Backman, E Mervaala, P H Rosenberg
Local anesthetic toxicity is thought to be mediated partly by inhibition of cardiac mitochondrial function. Intravenous (i.v.) lipid emulsion may overcome this energy depletion, but doses larger than currently recommended may be needed for rescue effect. In this randomized study with anesthetized pigs, we compared the effect of a large dose, 4 mL/kg, of i.v. 20% Intralipid(®) (n = 7) with Ringer's acetate (n = 6) on cardiovascular recovery after a cardiotoxic dose of bupivacaine. We also examined mitochondrial respiratory function in myocardial cell homogenates analyzed promptly after needle biopsies from the animals...
May 24, 2016: Human & Experimental Toxicology
https://www.readbyqxmd.com/read/27212746/effect-of-intrathecal-hyperbaric-bupivacaine-with-small-dose-clonidine-versus-hyperbaric-bupivacaine-alone-in-lower-abdominal-surgeries-a-comparative-study
#19
Amit Tyagi, Shivani Rastogi, Manoj Tripathi, Rajlaxmi Bhandari, Prateek Singh Bais, Mahendra Singh
CONTEXT: The continued success of regional anesthetic techniques can be credited due to improved local anesthetic drugs, with lower toxicities and longer duration of action, but still many efforts are being done to increase the duration of the block and postoperative analgesia. Therefore, use of adjuvant drugs for anesthesia is intended to prolong analgesia and preventing deleterious clinical effects of local anesthetics. AIMS: The present study is designed to evaluate effects of intrathecal hyperbaric bupivacaine versus hyperbaric bupivacaine with low dose clonidine on the onset and level of sensory and motor block, the intensity of motor blockade, and time of analgesia required in the postoperative period...
May 2016: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/27085700/in-vivo-effects-of-bupivacaine-and-gadobutrol-on-the-intervertebral-disc-following-discoblock-and-discography-a-histological-analysis
#20
Patrick Strube, Berit M Pfitzner, Florian Streitparth, Tony Hartwig, Michael Putzier
OBJECTIVES: The aim of the present study was to histologically compare chondrotoxicity in surgically harvested intervertebral discs (IVDs) of patients following discoblock, discography, or no preoperative intervention. METHODS: Thirty patients (IVD degeneration Modic ≥ 2°, Pfirrmann 3° or 4°) at L4/5 or L5/S1 who were planned for anterior lumbar interbody fusion were randomly assigned to three groups (open MRI: group DG - discography with gadobutrol; group DB - discoblock with bupivacaine at 4 weeks prior to surgery; group C - no intervention)...
January 2017: European Radiology
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