Bupivacaine adverse events

Spinal myoclonus is postulated to be caused by reduced activity of inhibitory pathways at the level of motor neurons or intemeu-rons. It is a rare self-limiting adverse event and has so far been evoked by bupivacaine and prilocaine. Diazepam has been reported to be effective in the past, but did not convince in this case. 

In a review of the literature on adverse events associated with intravenous regional anesthesia the author concluded that Bier s block is safe when anesthetic doses are kept low [46 ]. Seizures have been reported at doses as low as 1.4 mg/kg of hdocaine, 4 mg/kg of prilocaine, and 1.6 mg/kg of bupivacaine. Serious cardiac events have only been reported with hdocaine and bupivacaine. 

In neither of the last two cases was there motor blockade or neonatal sequelae. Such adverse effects can be caused by sufentanil, bupivacaine, or both. Regardless of which drug caused these events, the intrathecal administration of a hypobaric solution to a patient in the sitting position might have contributed, since rostral spread of intrathecal drugs is accelerated in this setting. The use of smaller doses of sufentanil (2.5 or 5 micrograms) will also prevent such adverse effects. 

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