Bupivacaine

Convulsions with hypoxia and acidosis Four cases of bupivacaine-induced convulsions accompanied by hypoxia and acidosis are described. The patients were female, aged 40-60 years, weighing 53-79kg. In 3 patients convulsions occurred within 2 min after single injections of epidural bupivacaine, while in the fourth patient convulsions occurred 10 min after completion of an intercostal nerve block. All had hypoxia and I or acidosis and were ventilated with 100 % oxygen within IS sec of the onset of convulsions which were controlled by thiopentone or diazepam. Only a small amount of bupivacaine must have entered the vascular system as all patients had analgesia adequate for surgery. None of the patients had any evidence of cardiotoxicity. In all cases adrenaline was included with the bupivacaine. Of 20,748 regional blocks (5277 intercostal, 11,839 epidural) performed with bupivacaine and adrenaline only 28 patients have suffered convulsions but none have had cardiac arrest. There is no evidence, therefore, tnat bupivacaine is more cardiotoxic than the shorter acting local anaesthetics but ... 'any de/ay in the proper treatment of associated hypoxia and acidosis can trigger cardiac arrest. ' Moore, D.C. <tal.: Anestllesiolagy 56: nO/lllar 1982)

0157-7271/82/0514-0003/0$01.00/0 © ADIS Press Reactions 14 May 1982 3