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At least 19 recordsLinked to original sources

PubMed1979

Continuous mini-infusion of bupivacaine into the epidural space during labor. Part II: Blood concentration of bupivacaine.

Mini-infusion of 0.25 per cent bupivacaine plain into the epidural space was used in 16 healthy women for pain relief during labor. After a loading dose, continuous administration was ensured by using an automatic pump at an infusion rate of 5 or 8 ml per hour. Maternal venous blood concentrations of bupivacaine were determined 20, 40, and 60 minutes after the loading dose. Further samples were taken hourly until delivery. Fetal blood concentrations were determined from fetal scalp blood during mini-infusion, and from umbilical venous blood at delivery. Maternal blood levels averaged 206 ng/ml. The maximum concentration (604 ng/ml) did not exceed 30 per cent of the toxic level. The blood concentration of bupivacaine did not tend to increase during the course of continuous infusion. Tachyphylaxis could not be detected statistically. The fetal blood concentration during blockade averaged 58 ng/ml, giving a feto-maternal ratio of 0.28. The neonatal-maternal ratio, calculated from the umbilical venous blood, was 0.32. With a shift of the acid-base status towards acidosis in the neonate, the ration of bupivacaine slightly increased. Absence of maternal hypotension as well as absence of fetal heart irregularities during infusion may be attributed to the low and stable blood concentration of bupivacaine. The mean Apgar score was 9.5 at one minute and 9.9 at five minutes. The maternal arterial acid-base balance at delivery was normal. The fetal acid-base status at delivery showed wide variation, without any relation to the Apgar score or the total dose of bupivacaine. It is concluded that continuous mini-infusion of bupivacaine by means of an automatic pump has advantages over intermittent administration.

Anesthesia, Epidural↗

PubMed1979

Comparison of a chloroprocaine--bupivacaine mixture with chloroprocaine and bupivacaine used individually for obstetric epidural analgesia.

Continuous lumbar epidural anesthesia was instituted in 49 healthy parturients who were randomly assigned to three treatment groups: 14 patients received chloroprocaine, 3 per cent; 19 received bupivacaine, 0.5 per cent, and 16 received a mixture containing chloroprocaine, 1.5 per cent, and bupivacaine, 0.375 per cent. Observations relating to the characteristics of the anesthetic block and to maternal and fetal well-being were made by a trained nurse observer. Times to onset of analgesia, times to maximum block, and adequacies of analgesia were similar in all groups. Bupivacaine lasted significantly longer than chloroprocaine or the mixture (68 versus 50 and 52 min, respectively, for the first injection), and caused the least motor block. No clinical superiority could be demonstrate for the mixture as compared with bupivacaine or chloroprocaine used individually. There was no sign of material or fetal toxicity with any of the three treatment regimens.

Anesthesia, Epidural↗

PubMed1979

Local anesthetics: importance of mode of application, concentration and adrenaline for the appearance of nerve lesions. An experimental study of axonal degeneration and barrier damage after intrafascicular injection or topical application of bupivacaine (Marcain).

Local anesthetics are designed for application in or close to nerve tissue. In spite of their wide clinical use, surprisingly few investigations deal with the neural toxicity of modern local anesthetics. In this experimental study, the effects were investigated of intrafascicular or topical application of the long-acting local anesthetic bupivacaine on the rabbit sciatic nerve. Axonal degeneration was histologically evaluated and a fluorescence-microscopic technique used to detect lesions in the blood-nerve barrier. Topical application of bupivacaine in clinically recommended concentrations around the nerve caused no detectable nerve injury, while intrafascicular injections caused considerable axonal degeneration and damaged the blood nerve barrier. Axonal degeneration was the same after injection of physiologic saline solution and bupivacaine 0.5%, but it increased with increasing bupivacaine concentration and especially with the addition of adrenaline. On the other hand, the acute effects of intrafascicular injection, as visualized in the barrier experiments, changed little with the addition of adrenaline, indicating that it is the injection trauma itself which is deleterious. It is concluded that intraneural injections should be avoided and that plain bupivacaine solutions should be routinely used.

Administration, Topical↗

PubMed1979

The effects of maternally administered pethidine or epidural bupivacaine on the fetus and newborn.

The continuous fetal heart rate rate pattern, condition of the baby at birth and its subsequent behaviour were compared in three groups of infants whose mothers received during labour either no drugs, intramuscular pethidine or epidural bupivacaine. The blood levels of pethidine and bupivacaine were measured at delivery in a maternal vein, and umbilical artery and vein, and in the newborn during the first 48 hours of life. The only significant changes in the fetal heart rate pattern occurred in association with maternal hypotension or uterine hyperstimulation. The Apgar scores at one minutes were 7 or less in more infants in the intramuscular pethidine and epidural bupivacaine groups as compared with the controls. There were no differences in the Apgar scores at five minutes. Neonatal behaviour during the first six weeks of life was not significantly affected by pethidine or epidural bupivacaine when compared with the control group. Pethidine and bupivacaine were shown to cross the placenta freely. The half-life of these drugs in the newborn was longer than in the adult.

Anesthesia, Epidural↗

PubMed2026

Effect of different liposomal bupivacaine concentrations in ultrasound-guided superior trunk block on postoperative analgesia and mobility: a randomized double-blind controlled trial protocol for shoulder arthroscopy.

BACKGROUND: Shoulder arthroscopy frequently causes severe postoperative pain that may impede recovery. Liposomal bupivacaine provides prolonged analgesia, and ultrasound-guided superior trunk block (STB) offers comparable analgesia to interscalene block with a lower risk of hemidiaphragmatic paralysis. However, the optimal concentration of liposomal bupivacaine for STB remains unknown. METHODS: This randomized, double-blind, controlled trial will enrol 282 adult patients scheduled for elective arthroscopic rotator cuff repair. Patients will be randomly allocated (1:1:1) to receive ultrasound-guided STB with liposomal bupivacaine 66 mg (Group A), 44 mg (Group B) or 33 mg (Group C), each diluted to 10 mL. The co-primary outcomes are (1) rest pain Numeric Rating Scale (NRS) score at 48 h post-surgery and (2) cumulative oral morphine milligram equivalents (MME) consumption within 0-48 h after surgery. Secondary outcomes include rest pain NRS scores at 6, 24 and 72 h; motor function assessed by Muscle Balance Scale, Bromage score and American Shoulder and Elbow Surgeons (ASES) score at 6, 24, 48 and 72 h; and Quality of Recovery-15 (QoR-15) score at 24 and 48 h. DISCUSSION: This study will provide evidence on the optimal concentration of liposomal bupivacaine for STB in arthroscopic shoulder surgery, aiming to achieve effective and prolonged analgesia without compromising shoulder mobility.

Humans↗

PubMed1976

Extradural analgesia in obstetrics: a controlled trial of carbonated lignocaine and bupivacaine hydrochloride with or without adrenaline.

Four local anaesthetic solutions (2% carbonated lignocaine with or without adrenaline and 0.5% bupivacaine HCl with or without adrenaline) were used randomly for 335 continuous lumbar extradural blocks in labour. Carbonated lignocaine caused a more rapid onset of analgesia than bupivacaine HCl. The addition of adrenaline made little difference to the onset times, prolonged markedly the duration of analgesia with carbonated lignocaine and had little effect on the duration of analgesia with bupivacaine HCl. Tachyphylaxis was a feature with carbonated lignocaine and adrenaline, but not with the other solutions. The incidence of unblocked segments was 7-9% in the four groups. The incidence of unilateral analgesia was 6% with plain lignocaine and 13% in the other groups. Complete pain relief occurred more frequently with bupivacaine HCl than with carbonated lignocaine and the use of adrenaline had little effect on the degree of analgesia.

Anesthesia, Epidural↗

PubMed1977

Relation of etidocaine and bupivacaine toxicity to rate of infusion in rhesus monkeys.

The relationship between infusion rate of etidocaine and bupivacaine and central nervous system toxicity was studied in three rhesus monkeys. Increasing the infusion rate from 0.5 to 2.0 mg/kg.min-1 decreased the seizure dosage of etidocaine but had no effect on that of bupivacaine. Arterial plasma concentrations of etidocaine and bupivacaine that induced electrical seizure activity increased as the infusion rate was increased from 0.5 to 1.0 mg/kg. min-1. A plasma decay study in a fourth animal demonstrated that etidocaine decayed more rapidly than did bupivacaine. These results suggest that the rate of administration of these agents is important in determining central nervous system toxicity.

Acetanilides↗

PubMedDate not supplied

Neonatal respiration, feeding and neurobehavioural state. Effects of intrapartum bupivacaine, pethidine and pethidine reversed by naloxone.

The effects on mature newborn have been compared at 0.5, 4, 8 12 24 and 48 hr after birth, of maternally administered epidural bupivacaine (11 babies) or pethidine (18 babies) or pethidine reversed by naloxone administered intramuscularly to the newborn (15 babies). Bupivacaine (mean dose 130 mg) had less effect that pethidine (mean dose 183.3 mg) on alveolar carbon dioxide tension (PACO2) at 0.5 hr after birth, but had a similar effect to pethidine on feeding, elicited reflexes and produced more depression of muscle tone up to 48 hr. Bupivacaine had more effect on PACO2 feeding measures, elicited reflexes and muscle tone at almost all examination periods than pethidine (mean dose 157.0 mg) reversed by naloxone (200 micrograms intramuscularly). Except at delivery, the effects of bupivacaine or pethidine on respiration and feeding up to 48 hr after birth were similar. There were more signs of depression with both drugs than when pethidine had been reversed by naloxone.

Anesthesia, Epidural↗

PubMed1979

Continuous mini-infusion of bupivacaine into the epidural space during labor. Part III: A clinical study of 225 patients.

Obstetric analgesia was accomplished by segmental continuous blockade in 225 women. The technique involved automatic pump infusion of 0.25 per cent bupivacaine solution into the epidural space at a rate of 5 ml per hour after initial doses of 2 and 5 ml bupivacaine. If the analgesia was insufficient one or two single injections of 5 ml of bupivacaine were added. Statistical evaluation of the results could be carried out for 218 women, 158 of whom were nulliparae and 60 multiparae. Fully satisfactory analgesia was achieved in 96 per cent of the nulliparae and 88 per cent of the multiparae in the first stage of labor. In the second stage of labor 46 per cent of the mothers were given pudendal blockade to maintain statisfactory analgesia. The positioning of the patient in the first stage of labor from supine to semirecumbent was of importance to spread the analgesic agent caudally, to the sacral nerve roots, and to control the pain due to stretching of the vagina and perineum. In the total material 17 per cent of the neonates were delivered by vacuum extraction. When the infusion into the epidural space was started in early labor, the incidence of vacuum extraction was 9 per cent, as compared with 38 per cent when it was started at 6 cm cervical dilatation or later (p less than 0.01). 9.8 per cent of the neonates were delivered by cesarean section. Fetal head malposition occurred in 8.7 per cent. A drop in blood pressure was noted in 7 per cent of the women. The condition of the newborn was unaffected by the analgesia. The mini-infusion system minimized the risk for infection. The danger in case of accidental intravascular injection was reduced, due to slowly administered bupivacaine. At the maternity department this technique has created a positive attitude towards epidural blockade, as midwives and doctors have found it safe and easy.

Anesthesia, Epidural↗

PubMed1979

Melanin capacity to accumulate drugs in the internal ear. A study on lidocaine, bupivacaine and chlorpromazine.

The distribution and retention of labelled lidocaine, bupivacaine, and chlorpromazine to melanin in the internal ear after intravenous and intraperitoneal injection were examined by whole-body autoradiography. Both young pigmented hooded rats and albino rats were studied. In the pigmented rats chlorpromazine showed the greatest accumulation, which was more pronounced in the cochlea than in the vestibular portion. The other two substances were evenly distributed in the internal ear. After a single injection of chlorpromazine and of bupivacaine these substances were still bound to the melanin of the internal ear after 14 days, which was the longest survival time. Lidocaine, on the other hand, had disappeared after only 4 days. Strong uptake and retention of the three substances were observed in the eyes of pigmented animals. In albino animals there was very weak, transient uptake in the internal ear of chlorpromazine and bupivacaine, but not of lidocaine. In studies in vitro on isolated bovine eye melanin there was considerably greater adsorption of chlorpromazine than of lidocaine and bupivacaine. An uptake was noted in the human eye in experiments in vitro. Clinical tests revealed no acute or late damage to hearing or sight after large doses of lidocaine. The participation of melanin in different basal labyrinthine functions such as the energy transfer mechanism and the sound protective mechanism is discussed in the light of the results obtained. Further, the theory is put forward that the melanin affinity of certain substances can be of both therapeutic and ototoxic importance.

Animals↗

PubMed1979

[Isobaric spinal anaesthesia with bupivacaine and tetracaine (author's transl)].

4 ml 0.5% solutions of bupivacaine and tetracaine without the addition of a vasoconstrictor, approximately isobaric, were used for spinal anaesthesia on patients in the sitting position. The sensory and motor block due to the two local anesthetics was tested and compared. The mean time on onset of complete analgesia was the same for both local anaesthetics (9 and 11 min), as was also the highest level of analgesia (T10). The duration of maximal extension of analgesia was on an average 45 min longer due to tetracaine (bupivacaine 105 min, tetracaine 150 min). The duration of maximal spread of the blocked sensation of pain, temperature, pressure and touch was similar for each of both local anesthetics. The regression of these sensory qualities, blocked in a dissoaciated manner, took a parallel course. With tetracaine the motor block of the lower extremities developed faster and lasted longer (Bromage 3 for bupivacaine 192 min, for tetracaine 220 min). Motor function and proprioception normalized in a synchronized manner. Isobaric spinal anaesthesia with these two solutions of local anaesthetics was found to be reliable and controllable, especially when administered to the sitting patient. Tetracaine is a good alternative to bupivacaine, currently controversial for intrathecal use.

Anesthesia, Spinal↗

PubMed1979

The effect of bupivacaine aerosol on the activity of pulmonary stretch and 'irritant' receptors.

1. Experiments have been done on anaesthetized, paralysed and artificially ventilated cats. 2. Vagal single afferent fibres showing discharges in phase with respiration were isolated in the neck. Two types of fibres were studied at different tidal volumes: (i) showing slowly adapting discharges from the pulmonary stretch receptors; (ii) showing rapidly adapting discharges from the lung 'irritant' receptors. The effect of bupivacaine aerosol, administered by positive pressure inflations, was recorded on the pattern of fibre discharge. 3. The pulmonary stretch fibres were further classified into low-threshold and higher-threshold fibres according to the standard criteria. Bupivacaine aerosol blocked activity in all the low-threshold and in the majority of the higher-threshold fibres. 4. Of the rapidly adapting fibres, bupivacaine completely blocked activity at some tidal volumes and markedly reduced it at most others. 5. The fibre activity data are presented. It is concluded that although bupivacaine aerosol markedly reduced impulse activity in all three types of fibres, the data suggest that there is a small difference in the ease with which low-threshold fibres on the one hand and higher-threshold and "irritant" fibres on the other hand are affected. The reasons for this difference in the behaviour are not understood.

Action Potentials↗

PubMed1979

Blood bupivacaine levels in standard and segmental epidural blockade in obstetrics.

A statistically significant reduction in maternal blood bupivacaine levels could be achieved by using a segmental epidural blockade and lower concentrations of bupivacaine. Since bupivacaine has certain potential disadvantages for the mother and the fetus, its dosage should be kept as low as possible. Significantly lower blood levels without loss of analgesic quality are obtainable by using segmental epidural blockade and a lower concentration of bupivacaine.

Anesthesia, Caudal↗

PubMed1979

Cytotoxic effects of procaine, lignocaine and bupivacaine.

Cytotoxic effects of procaine, lignocaine and bupivacaine were investigated on cultures of Chinese hamster lung fibroblasts. Cell growth was inhibited over 24 h exposures with an ED50 of 0.17% for procaine, 0.07% for lignocaine and 0.02% for bupivacaine. Cell survival (measured as colony-forming ability) was reduced over 24 h exposure with an ED50 of 0.21% for procaine, 0.09% for lignocaine and 0.06% for bupivacaine. Morphological changes included vacuolation, cell rounding and retraction from the surface on which the cells were growing. Motility was reduced to about 50% of control by lignocaine 0.1%. On removal of the local anaesthetics, cell growth was resumed after about 15 h without evidence of chromosome damage. Corresponding changes induced by inhalation anaesthetics are only seen at two to three times the minimal alveolar concentration required for anaesthesia.

Animals↗

PubMed1979

Effects of maternal position on epidural anesthesia for cesarean section, acid-base status, and bupivacaine concentrations at delivery.

In 25 patients excellent clinical anesthesia for elective cesarean section was obtained with lumbar epidural block using an average dose of bupivacaine of 130 mg (18 ml of 0.75 per cent solution). Supplemental drugs were not needed. All infants had normal Apgar scores at delivery. Ten patients were kept in a 35--40 degree semi-sitting supine position during induction, while 15 patients were similarly semi-sitting but turned into the left lateral position. Maternal position did not affect the adequacy of the anesthesia or the clinical condition of the infants, but did alter acid-base state and bupivacaine concentrations in the infants. At delivery, the infants whose mothers had been supine had significantly lower pH values in umbilical cord blood than those whose mothers had been in the lateral position. Also, high concentrations of bupivacaine were found in the umbilical vein blood of infants whose mothers were supine.

Acid-Base Equilibrium↗

PubMed1978

0.125% bupivacaine for obstetric analgesia?

A prospective trial was designed to assess the effectiveness of three different concentrations of bupivacaine (Marcain) for use in obstetric epidural analgesia. The purpose of the study was to see if reduction of the concentration of bupivacaine to 0.125% would reduce the total dose of the drug given without reducing the efficiency of the epidural block. The concentrations studies were 0.125%, 0.25% and 0.375%. The trial was limited to fit primiparous patients at term with singleton pregnancies and vertex presentation. Patients with intercurrent medical disease or with toxaemia were excluded. A total of ninety-three patients were studied, and once admitted to the trial they were randomly allocated to one of the three concentrations. In general the results of the trial show that 0.125% bupivacaine had a significantly higher failure rate than either of the other two concentrations, but in those cases where 0.125% was effective and achieved total pain relief there was a significant reduction in the amount of the drug used.

Anesthesia, Epidural↗

PubMed1979

Intravenous regional analgesia using bupivacaine. A double blind comparison with lignocaine.

A double-blind comparison of bupivacaine and lignocaine for intravenous regional analgesia (Bier's block) was carried out in seventy-two patients presenting for upper limb surgery. Thirty-eight patients received lignocaine and thirty-four received bupivacaine. Onset of analgesia and recovery times were similar for the two drugs. The degree of both analgesia and muscle relaxation was significantly better in the bupivacaine group. Adverse effects were seen only in patients who had received lignocaine and these were unrelated to the tourniquet time.

Anesthesia, Conduction↗

PubMed1975

Lumbar epidural analgesia with bupivacaine in labor. Determination of drug concentration and pH in fetal scalp blood, and continuous fetal heart rate monitoring.

Lumbar epiduval analgesia with bupivacaine was given to 37 women for uncomplicated labor. After the blcokade serial determinations of pH and bupivacaine concentration were made in fetal scalp blood and maternal venous blood and there was continuous monitoring of the fetal heart rate. Fetal scalp blood pH was within normal limits and no pathologic FHR tracings were elicited by the blockade, although a temporary decrease of the baseline fetal heart rate irregularity was seen in about one-fifth of the cases. Fetal drug concentrations were low and about one-fourth of corresponding maternal values. After reinjection of bupivacaine the degree of drug accumulation was fairly similar in fetal and maternal blood.

Adolescent↗