Cardiac Resuscitation After Incremental Overdosage with Lidocaine, Bupivacaine, Levobupivacaine, and Ropivacaine in Anesthetized Dogs

Abstract

There were consistent differences among the local anesthetics, the sum of which suggests that larger doses and blood concentrations of ropivacaine (ROP) and lidocaine will be tolerated as compared with bupivacaine (BUP) and levobupivacaine (LBUP). Lidocaine intoxication results in myocardial depression from which resuscitation is consistently successful but will require continuing drug support. After BUP, LBUP, or ROP, resuscitation is not always successful, and the administration of epinephrine may lead to severe arrhythmias. The unbound plasma concentrations at collapse were larger for ROP compared with BUP, whereas the concentrations of LBUP and BUP were not significantly different from each other. Furthermore, larger plasma concentrations of ROP than BUP are present after resuscitation, suggesting a wider margin of safety when large volumes and large concentrations are used to establish upper or lower extremity nerve blocks for surgical anesthesia and during long-term infusions for pain management.

Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

“…Bupivacaine is still the most widely used agent, owing to its good quality of anesthesia and prolonged duration of action 1,2 . However, in 1979, an editorial of Anesthesiology 3 on the severe cardiovascular effects produced by accidental intravascular injections led to a search for new agents with lower toxicity and antidotes to combat their effects.…”

The use of lidocaine for fetocide in late termination of pregnancy

“…Sufentanil (5 Ag) was then injected followed 3 minutes later by lidocaine (1%). The initial dose was based on a lethal dose to be given to a 1000 g 28,29 fetus which can be estimated to be around 100 mg/kg while this would remain within the safe dose regimen for the mother in the event of accidental injection in the maternal circulation (2.8 -4.2 mg/kg) 30 . Failure was empirically defined as being unable to induce permanent asystole with a maximum of 300 mg of lidocaine while remaining below a toxic/convulsant dose for the mother (7 mg/kg) 31 .…”

A Prospective, Randomised, Double-Blind Comparative Clinical Study of 0.5% Bupivacaine and 0.75% Ropivacaine for Sciatic Nerve Block in Patients Undergoing Elective Below Knee Surgeries

“…Resuscitation after ropivacaine toxicity is more successful than bupivacaine. 7,8,9 Hence, we selected to compare these two drugs in our study.…”

“…5,6 Resuscitation after Ropivacaine toxicity is found to be more successful than Bupivacaine. 7,8,9 The improved safety profile of Ropivacaine may allow the use of higher concentrations to try and hasten the speed of onset. Ropivacaine is found to be half as potent as Bupivacaine, the potency ratio being 1.5:1 between Ropivacaine and Bupivacaine respectively.…”