Bupivacaine, a long-acting local anesthetic agent, is widely used for pain control in ambulatory surgery patients. Surgeons and anesthesiologists employ bupivacaine for cutaneous infiltration, intra-articular injection, peripheral nerve blocks, epidural anesthesia, and spinal anesthesia. Unlike lidocaine, bupivacaine is highly lipophilic. Accidental bupivacaine intravascular injection or excessive systemic absorption can lead to cardiac depression, severe arrhythmias, hypotension, and/or cardiac arrest. Resuscitation of patients with bupivacaine toxicity may be difficult, prolonged, and, in some cases, impossible. Heroic measures including cardiopulmonary bypass have been performed in cases in which conventional resuscitative measures failed. Lipid emulsion has recently been advocated as a new therapy to treat bupivacaine systemic toxicity. This article reports the successful resuscitation of a hand surgery patient after inadvertent intravascular injection of bupivacaine during axillary block and reviews the pertinent literature.
- •Describe lipid emulsion therapy.
- •List the indications for lipid emulsion therapy.
- •State the mechanism of action for lipid emulsion therapy.
- •Discuss the techniques to decrease the possibility of intravascular injection during axillary block.
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Accepted: October 19, 2009
Received: October 19, 2009
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
© 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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