Thirty years after the bupivacaine controversy: what have we learned?

Excerpt

In October 1979, Albright wrote an editorial warning of the risks of cardiac toxicity due to bupivacaine and etidocaine.1 The editorial followed a report by Prentiss concerning a cardiac arrest in a patient receiving caudal anesthesia with etidocaine.2 In that case, cardiovascular collapse followed the rapid onset of convulsions after possible intravascular (iv) injection of etidocaine. To Albright’s knowledge, this was the sixth anecdotal case of sudden cardiovascular collapse following presumed iv injection of bupivacaine (0.5% or 0.75%) or etidocaine. He suggested that inadvertent iv administration of clinical doses of etidocaine and bupivacaine, in comparison with other local anesthetics (LAs), could result in almost simultaneous central nervous system and cardiovascular system toxicity without preceding hypoxia. Albright also noted that resuscitation was difficult, prolonged, and, in most situations, the outcome was poor.1 …