Universal types of muscle fiber injuries associated with characteristic changes in the myofibrillar system predominate in the spectrum of reactions to acute disorders of cell metabolism caused by bupivacaine. Quantitative parameters of the pathogenic exposure and structural and metabolic characteristics of the target fibers largely determine these changes: pronounced contractures involving primarily white muscle fibers, high incidence of disseminated and mixed forms, among which a special variant with predominant lytic processes (cytolysis) was distinguished. Minimum changes in the contractile system were often paralleled by diffuse destruction of mitochondria, which attested to the role of these organelles in the development of muscle fibers alteration in this model.