Effect of Long-Term Intrathecal Bupivacaine Infusion on Blood Pressure

Intrathecal Drug Delivery: Advances and Applications in the Management of Chronic Pain Patient

“…Although long-term safety has been shown with bupivacaine infusions intrathecally in animal models, there are potential adverse effects, which include weakness, numbness, urinary retention, and hypotension (141,142). One study with 82 patients being treated with IDD revealed significant decreases in systolic blood pressure and mean arterial pressure over 1 year (143). The decreased blood pressure associated with long-term thoracic IT infusion of bupivacaine is thought to be secondary to blockade of sympathetic efferents (143).…”

“…One study with 82 patients being treated with IDD revealed significant decreases in systolic blood pressure and mean arterial pressure over 1 year (143). The decreased blood pressure associated with long-term thoracic IT infusion of bupivacaine is thought to be secondary to blockade of sympathetic efferents (143). The safety and efficacy of the lowdose intrathecal (IT) combination of ziconotide and morphine allows safe and rapid control of malignant pain refractory to oral opioids (94).…”

First Evaluation Switching From Ropivacaine to Highly Concentrated Bupivacaine in Intrathecal Mixtures for Cancer Pain

“…More specifically, for local anesthetics, we monitored the occurrence of neurological, respiratory, and hemodynamic AEs, such as sensory or motor blocks, blood pressure hypotension or drowsiness. To avoid underestimating hypotension side effects secondary to IT bupivacaine infusion, we assessed blood pressure right before the refill, and we took into account the lowest blood pressure on the patient's chart during the 24-hour surveillance following the refill (10). ROBUMIX was a retrospective follow-up study; every reported AE in the above-mentioned fields was attributed to bupivacaine.…”

“…Guidelines are now well established regarding its indications and management (3)(4)(5). A combination of drugs (morphine and bupivacaine) is recommended in first line therapy for cancer patients, as it has been demonstrated that combining opioids with local anesthetics is more efficacious in pain relief (6)(7)(8)(9)(10).…”

“…Bupivacaine has been widely used since the availability of IDDS, thus becoming the gold standard as the first line local anesthetic in intrathecal analgesia throughout the world, repeatedly recommended in guidelines (3,11). Its intrinsic pharmacokinetic effects as well as its synergistic effect with opioids have been widely studied and are well known (6,(8)(9)(10)(12)(13)(14)(15)(16).…”