Reactions 455 - 12 Jun 1993

★Bupivacaine

First report of cholestasis after interpleuraladministration: 3 case reports

Elevation of liver enzyme levels occurred in 3 women, aged32, 55 and 44 years, after they received bupivacaine via a right-sided interpleural catheter for the treatment of chronic armpain. All patients received 6 or 7 doses of 0.5% bupivacaine30ml over a 2-week period. In two of the women, jaundice andfever were present. Leucopenia and eosinophilia were alsopresent, respectively. Liver aspiration cytology revealed toxiccholestasis in both women. Liver enzyme levels returned tonormal within 1 and 2 months, respectively. Liver enzymeelevation was asymptomatic in the third woman.

Author comment: Although other published reports ofcholestasis with bupivacaine could not be found, there havebeen anecdotal reports of hepatic adverse effects with thedrug, and a single case of jaundice after interpleuralbupivacaine. The manufacturer claims that there were noreports of liver damage with bupivacaine in animal studies.‘The scarcity of reports is puzzling in view of our experience,with cholestasis occurring in 3 of 10 treated cases (of arm pain).. We recommend prudent monitoring of liver enzymes whenrepeated doses of interpleural bupivacaine are given for painrelief, especially when the right pleural cavity is used.’Billstrom R, et al. Cholestasis after interpleural bupivacaine for chronic upper limbpain. Anesthesia and Analgesia 76: 1158-1159, May 1993 - Sweden 800200163

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Reactions 12 Jun 1993 No. 4550114-9954/10/0455-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved