UMEM Educational Pearls

Category: Toxicology

Title: Bupivacaine

Keywords: cardiotoxicity, marcaine, bupivacaine (PubMed Search)

Posted: 11/20/2008 by Fermin Barrueto, MD (Updated: 12/7/2019)
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Local Anesthetic - Bupivacaine (Marcaine) - Sodium channel blocker with duration of action 2-4 hrs (w/epi 3-7 hrs) - Toxic dose is > 2.5 mg/kg or > 175 mg total dose (Infiltrating into SQ) - Bupivacaine 0.25% = 2.5 mg/mL - Inadvertent intravenous injection can result in toxicity - Lethally cardiotoxic with widened QRS, V-tach and neurotoxic with inebriation and seizures - Anesthesia literature reports successful use of Intralipid as an antidote