Chemical Stability of Bupivacaine in pH-adjusted Solutions

Bonhomme, L.; Benhamou, Dan; Jebri, Magid; Bourget, P.; Martre, H.; Postaire, E.; Préaux, Nicole

doi:10.1097/00000542-198811000-00019

Cited by 17 publications

(10 citation statements)

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“…This method is known to reduce the time to onset (3) and to increase the duration of sensory block ( 3 , 4) during regional anesthesia. However, in the same previous report (1,2) as well as in others (5), the increase in p H of bupivacaine solutions led to precipitation, which is possibly harmful for tissues. The aim of this study was thus to determine how physical and chemical factors influence precipitation in pH-adjusted solutions of bupivacaine.…”

Section: Introductionmentioning

confidence: 55%

FACTORS INFLUENCING PRECIPITATION OF pH-ADJUSTED BUPIVACAINE SOLUTIONS

1990

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Solutions of bupivacaine precipitate when bicarbonate is added. This limits the clinical use of pH-adjustment in optimizing bupivacaine activity. In this study four different bupivacaine solutions were studied with the addition of sodium bicarbonate at 4 degrees C or 20 degrees C. Bupivacaine concentrations remained unchanged after pH-adjustment. Least crystallization was observed with bupivacaine solutions containing a small amount of sodium bicarbonate and stored at 4 degrees C.

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Section: Introductionmentioning

confidence: 55%

FACTORS INFLUENCING PRECIPITATION OF pH-ADJUSTED BUPIVACAINE SOLUTIONS

1990

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“…Bonhomme et al . demonstrated stability of buffered bupivacaine (pH 6.8–7.0) with and without adrenaline over 6 h but did not test for a longer duration 47 . Robinson et al .…”

Section: Discussionmentioning

confidence: 99%

“…Bonhomme et al demonstrated stability of buffered bupivacaine (pH 6.8-7.0) with and without adrenaline over 6 h but did not test for a longer duration. 47 Robinson et al tested bupivacaine at 24 h and found no significant degradation. 45 The concentration of adrenaline in buffered solutions declines more rapidly though studies are conflicting.…”

Section: Stabilitymentioning

confidence: 99%

Buffering the pain of local anaesthetics: A systematic review

Davies

2003

Emergency Medicine

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Objective: To review the evidence that buffering of local anaesthetics with sodium bicarbonate reduces the pain of injection whilst not affecting efficacy. Methods: Medline search from 1966 to December 2001. Articles in all languages were included. Bibliographies were examined for papers. Results: The search identified 63 publications. All were retrieved. Of these, 22 were human prospective randomized controlled trials directly assessing the pain of infiltration. Three papers were based on observations. No case series, case reports, or retrospective studies were identified. One animal study was found. Conclusion: The evidence is that buffering with sodium bicarbonate significantly reduces the pain of local anaesthetic injection. The buffered solutions retain the efficacy of local anaesthetics and are stable in the mixtures used in the trials. Adrenaline‐containing buffered solutions need refrigeration in closed containers for storage. Buffering will be particularly useful where pain of local anaesthetic injection may not be well tolerated such as in large areas of infiltration, sensitive areas such as the face and in children. It is recommended that sodium bicarbonate and tables of stable dilutions are readily available in the emergency department to facilitate this.

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“…It is well documented that the chemical stability of epinephrine decreases significantly following alkalinization because increasing the pH of LA solutions favours the oxidation of epinephrine (3,8). What is unclear is the chemical stability of epinephrine in buffered solutions for prolonged periods of time (23)(24)(25)(26)(27)(28)(29). Until stability issues are better explained, we recommend buffering solutions containing epinephrine just before use.…”

Section: Areas For Further Workmentioning

confidence: 99%