Skip to main content
Anesthesia Progress logoLink to Anesthesia Progress
. 1999 Spring;46(2):56–62.

Cardiovascular effects of bupivacaine and the role of this agent in preemptive dental analgesia.

O J Younessi 1, A Punnia-Moorthy 1
PMCID: PMC2148896  PMID: 10853566

Abstract

Inappropriately high blood concentrations of bupivacaine have been reported to cause toxicity and even death. The potential for cardiovascular toxicity and the difficulty with which this may be reversed has made the dental practitioners reluctant to use this agent. Nevertheless, cardiovascular toxicity from its use in and around the mouth is exceedingly rare. This study was undertaken to assess bupivacaine's cardiotoxic potential in the practice of oral and maxillofacial surgery. Results showed a dose-dependent decrease in systolic blood pressure, but no other statistically significant cardiovascular change was noted. Preemptive treatment of postsurgical pain has been the subject of numerous trials. Bupivacaine administered preoperatively has been suggested to prevent central nervous system "conditioning," thus decreasing the perceived postoperative pain. However, there was no statistical support for any reduction in the perceived postoperative pain in the treatment groups in this study.

Full text

PDF
58

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Atlee J. L., 3rd, Bosnjak Z. J. Mechanisms for cardiac dysrhythmias during anesthesia. Anesthesiology. 1990 Feb;72(2):347–374. doi: 10.1097/00000542-199002000-00022. [DOI] [PubMed] [Google Scholar]
  2. Chapnick P., Baker G., Munroe C. O. Bupivacaine anaesthesia in oral surgery. J Can Dent Assoc. 1980 Jul;46(7):441–443. [PubMed] [Google Scholar]
  3. Cook A. J., Woolf C. J., Wall P. D., McMahon S. B. Dynamic receptive field plasticity in rat spinal cord dorsal horn following C-primary afferent input. Nature. 1987 Jan 8;325(7000):151–153. doi: 10.1038/325151a0. [DOI] [PubMed] [Google Scholar]
  4. Goldstein D. S., Dionne R., Sweet J., Gracely R., Brewer H. B., Jr, Gregg R., Keiser H. R. Circulatory, plasma catecholamine, cortisol, lipid, and psychological responses to a real-life stress (third molar extractions): effects of diazepam sedation and of inclusion of epinephrine with the local anesthetic. Psychosom Med. 1982 Jul;44(3):259–272. doi: 10.1097/00006842-198207000-00004. [DOI] [PubMed] [Google Scholar]
  5. Mazoit J. X., Denson D. D., Samii K. Pharmacokinetics of bupivacaine following caudal anesthesia in infants. Anesthesiology. 1988 Mar;68(3):387–391. doi: 10.1097/00000542-198803000-00011. [DOI] [PubMed] [Google Scholar]
  6. Neal J. A., Welch T. B., Halliday R. W. Analysis of the analgesic efficacy and cost-effective use of long-acting local anesthetics in outpatient third molar surgery. Oral Surg Oral Med Oral Pathol. 1993 Mar;75(3):283–285. doi: 10.1016/0030-4220(93)90136-r. [DOI] [PubMed] [Google Scholar]
  7. Salonen M., Forssell H., Scheinin M. Local dental anaesthesia with lidocaine and adrenaline. Effects on plasma catecholamines, heart rate and blood pressure. Int J Oral Maxillofac Surg. 1988 Dec;17(6):392–394. doi: 10.1016/s0901-5027(88)80071-7. [DOI] [PubMed] [Google Scholar]
  8. Scott D. B. Evaluation of the toxicity of local anaesthetic agents in man. Br J Anaesth. 1975 Jan;47(1):56–61. doi: 10.1093/bja/47.1.56. [DOI] [PubMed] [Google Scholar]
  9. Scott D. B. Toxicity caused by local anaesthetic drugs. Br J Anaesth. 1981 Jun;53(6):553–554. doi: 10.1093/bja/53.6.553. [DOI] [PubMed] [Google Scholar]
  10. Smith C. M., Guralnick M. S., Gelfand M. M., Jeans M. E. The effects of transcutaneous electrical nerve stimulation on post-cesarean pain. Pain. 1986 Nov;27(2):181–193. doi: 10.1016/0304-3959(86)90209-5. [DOI] [PubMed] [Google Scholar]
  11. Wall P. D. The prevention of postoperative pain. Pain. 1988 Jun;33(3):289–290. doi: 10.1016/0304-3959(88)90286-2. [DOI] [PubMed] [Google Scholar]
  12. de Jong R. H., Bonin J. D. Local anesthetics: injection route alters relative toxicity of bupivacaine. Anesth Analg. 1980 Dec;59(12):925–928. [PubMed] [Google Scholar]

Articles from Anesthesia Progress are provided here courtesy of American Dental Society of Anesthesiology

RESOURCES