Administración intencionada de bupivacaína /levobupivacaína intravenosa: revisión de la literatura. Caso clínico.
DOI:
https://doi.org/10.30445/rear.v6i3.216Palabras clave:
levobupivacaina intravenosa, Bupivacaina, Anestésicos locales, dolor agudo, dolor crónico, dolor neuropático, levobupivacainaResumen
Comunicamos el empleo de levobupivacaína en perfusión intravenosa para control del dolor agudo intenso de características neuropáticas en un paciente afecto de metástasis hepáticas y pulmonares tras ser sometido a una quimioembolización hepática.
Desde hace décadas se contempla el empleo de anestésicos locales por vía intravenosa con intención terapéutica, si bien el control del dolor ha sido la indicación más habitual y los anestésicos locales más comunmente empleados han sido la procaína y posteriormente la lidocaína. Es bien conocido que la bupivacaína posee un efecto anestésico/analgésico más potente que los 2 anestésicos anteriormente citados, pero los autores no conocemos referencias de su empleo sistémico. Es más, desde que el residente inicia su andadura como anestesiólogo es advertido de que la administración intravenosa accidental de bupivacaína causa serios efectos adversos e incluso el fallecimiento del paciente, lo cual sí ha sido documentado.
Citas
1.- Gordon RA. Intravenous procaine. Clinical applications. Can Med Assoc J 1948;59(6):534-535.
2.- Challapalli V, Tremont-Lukats IW, McNicol ED, Lau J, Carr DB. Systemic administration of local anesthetic agents to relieve neuropathic pain. Cochrane Database Syst Rev 2005;(4):CD003345.
3.- Albright GA. Editorial: Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979;51(4):285-287.
4.- Heath ML. Deaths after intravenous regional anesthesia. Br Med J (Clin Res Ed) 1982;285(6346):913-914.
5.- Heath ML. Bupivacaine toxicity and Bier blocks. Anesthesiology 1983;59;(5):481.
6.- Guay J. Adverse events associated with intravenous regional anesthesia (Bier block): a systematic review of complications. J Clin Anesth 2009;21(8):585-594.
7.- Errando CL, Freijo JJ, Vila M, Tardón L. Toxicidad de los anestésicos locales. Prevención y tratamiento. Rev Esp Anestesiol Reanim 2013;60(Supl 1):65-72.
8.- Gristwood R, Bardsley H, Baker H, Dickens J. Reduced cardiotoxicity of levobupivacaine compared with racemic bupivacaine (Marcaine): new clinical experience. Exp Opin Invest Drugs 1994;3(11):1209-1212.
9.- Leone S, Di Cianni S, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaína and levobupivacaine. Acta Biomed 2008;79(2):92-105.
10.- Kopacz J, Allen HW. Accidental intravenous levobupivacaine. Anesth Analg 1999;89(4):1027-1029.
11.- Pirotta D, Sprigge J. Convulsions following axillary brachial plexus blockade with levobupivacaine. Anesthesia 2002;57(12):1187-1189.
12.- Khan H, Atanasoff PG. Accidental intravascular injection of levobupivacaine and lidocaine during the transarterial approach to the axillary brachial plexus. Can J Anaesth 2003;50(1):95.
13.- Salomäki TE, Laurila PA, Ville J. Successful resuscitation after cardiovascular collapse following accidental intravenous infusión of levobupivacaine during general anesthesia. Anesthesiology 2005;103(5):1095-1096.
14.- Lenfant F, Volot F, Freysz M, Wilkening M. Le flumazenil corrige-t-il les troubles de la conduction intracardiaque induits par l’injection intraveineuse accidentelle de bupivacaine? Ann Fr Anesth Réanim 1996;15(8):1196-1198.
15.- Karaca S, Ünlüsoy EÖ. Accidental injection of intravenous bupivacaine. Eur J Anaesthesiol 2002;19(8):616-617.
16.- Favier JC, da Conceiçao M, Fassassi M, Allanic L, Steiner T, Pitti R. Successful resuscitation of serious bupivacaine intoxication in a patient with pre-existing heart failure. Can J Anesth 2003;50(1):62-66.
17.- Fuzaylov G, Ying B, Tang Y, Sethnas NF. Successful resuscitation after inadvertent intravenous injection of bupivacaine in an adolescent. Pediatr Anesth 2010; 20(10):958-959.
18.- Gómez Arnau JI, Bartolomé A, García del Valle S, Puebla G, Santa Úrsula JA, Marzal JM, Arnal D, González A, González R. Errores de medicación y etiquetado de las jeringas. Rev Esp Anestesiol Reanim 2013;60(Supl 1):27-33.
19.- Telivuo L, Katz RL. The effects of modern intravenous local analgesics on respiration during partial neuromuscular block in man. Anaesthesia 1970;25(1):30-35.
21.- Moore DC, Batra MS. The components of an effective test dose prior to epidural block. Anesthesiology 1981;55(6):693-696.
22.- van Zundert A, Vaes L, Soetens M, de Vel M, van der Aa, van der Donck, Meeuwis H, de Wolf A. Every dose given in epidural analgesia for vaginal delivery can be a test dose. Anesthesiology 1987;67(3):436-440.
23.- Mulroy M, Neal JM, Mackey DC, Harrington BE. 2-chloroprocaine and bupivacaine are unreliable indicators of intravascular injection in the premedicated patient. Reg Anesth Pain Med 1998;23(1):9-13.
24.- Polaner DM, Zuk J, Luong K, Pan Z. Positive intravascular test dose criteria in children during total intravenous anesthesia with propofol and remifentanil are different than during inhaled anesthesia. Anesth Analg 2010;110(1):41-45.
25.- Mauch JY, Spielmann N, Hartnack S, Weiss M. Electrocardiographic and haemodynamic alterations caused by three different test solutions of local anaesthetics to detect accidental intravascular injection in children. Br J Anaesth 2012;108(2):283-289.
26.- Gieraerts R, van Zundert A, de Wolf A, Vaes L. Ten ml bupivacaine 0.125% with 12.5µg epinephrine is a reliable epidural test dose to detect inadvertent intravascular injection in obstetric patients. A double-blind study. Acta Anaesthesiol Scand 1992;36(7):656-659.
27.- Mather LE, Long GJ, Thomas J. The intravenous toxicity and clearance of bupivacaine in man. Clin Pharmacol Ther 1971;12(6):935-943.
28.- Groeben H, Schwalen A, Irsfeld S, Stieglitz S, Lipfert P, Hopf HB. Intravenous lidocaine and bupivacaine dose-dependently attenuate bronchial hyperreactivity in awake volunteers. Anesthesiology 1996;84(3):533-539. (PubMed) (pdf) (epub)
29.- Jorfeldt L, Löfström B, Pernow B, Persson B, Wahren J, Widman B. The effect of local anaesthetics on the central circulation and respiration in man and dog. Acta Anaesthesiol Scand 1968;12(4):153-169.
30.- Scott DB, Jebson PJR, Boyes RN. Pharmacokinetic study of the local anaesthetics bupivacaine (Marcain) and etidocaine (Duranest) in man. Br J Anaesth 1973;45(10):1010-1012.
31.- Scott DB. Evaluation of the toxicity of local anaesthetic agents. Br J Anaesth 1975;47(1):56-61.
32.- Wiklund L. Human hepatic blood flow and its relation to systemic circulation during intravenous infusion of bupivacaine or etidocaine. Acta Anaesth Scand 1977;21(3):189-199.
33.- Mather LE, Tucker GT, Murphy TM, Stanton-Hicks MA, Bonica JJ. Cardiovascular and subjective central nervous system effects of long-acting local anaesthetics in man. Anaesth Intensive Care 1979;7(3):215-221.
34.- Hasselstrom LJ, Mogensen T, Kehlet H, Christensen NJ. Effects of intravenous bupivacaine on cardiovascular function and plasma catecholamine levels in humans. Anesth Analg 1984;63(12):1053-1058.
35.- Sundberg A, Wattwil M, Wiklund L. Haemodynamic effects of intravenous bupivacaine during high thoracic epidural anaesthesia. Acta Anaesthesiol Scand 1987;31(2):143-147.
36.- Burm AG, de Boer AG, van Kleef JW, Vermeulen NP, de Leede LG, Spierdijk J, Breimer DD. Pharmacokinetics of lidocaine and bupivacaine and stable isotope labeled analogues: a study in healthy volunteers. Biopharm Drug Dispos 1988;9(1):85-91.
37.- Scott DB, Lee A, Fagan D, Bowler GMR, Bloomfield P, Lundh R. Acute toxicity of ropivacaína compared with that of bupivacaine. Anesth Analg 1989;69(5):563-569.
38.- Burm AGL, van der Meer AD, van Kleef JW, Zeijlmans PWM, Groen K. Pharmacokinetics of the enantiomers of bupivacaine following intravenous administration of the racemate. Br J Clin Pharmacol 1994;38(2):125-129.
39.- Groeben H, Schwalen A, Irsfeld S, Tarnow J, Lipfert P, Hopf HB. High thoracic epidural anesthesia does not alter airway resistance and attenuates the response to an inhalational provocation provocation test in patients with bronchial hyperreactivity. Anesthesiology 1994;81(4):868-874.
40.- Knudsen K, Beckman-Suurküla M, Blomberg S, Sjövall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaína, bupivacaine and placebo in volunteers. Br J Anaesth 1997;78(5):507-514.
41.- Litonius E, Tarkkila P, Neuvonen PJ, Rosenberg PH. Effect of intravenous lipid emulsion on bupivacaine plasma concentration in humans. Anaesthesia 2012;67(6):600-605.
42.- Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol 1998;46(3):245-249.
43.- Stewart J, Kellett N, Castro D. The central nervous system and cardiovascular effects of levobupivacaine and ropivacaína in healthy volunteers. Anesth Analg 2003;97(2):412-416.
44.- Owen MD, Gautier P, Hood DD. Can ropivacaine and levobupivacaine be used as test doses during regional anesthesia? Anesthesiology 2004;100(4):922-925.
45.- Hasselstrom LJ, Mogensen T. Toxic reaction of bupivacaine at low plasma concentration. Anesthesiology 1984;61(1):99-100.
46.- Tucker GT, Mather LE. Pharmacokinetics of local anesthetic agents. Br J Anaesth 1975;47suppl:213-224.
47.- Mather LE, Copeland SE, Ladd LA. Acute toxicity of local anesthetics: underlying pharmacokinetic and pharmacodynamic concepts. Reg Anesth Pain Med 2005;30(6):553-566.
48.- Scott DB. Toxic effects of local anaesthetic agents on the central nervous system. Br J Anaesth 1986;58(7):732-735.
49.- Gantenbein M, Attolini L, Bruguerolle B, Villard PH, Puyoou F, Durand A, Lacarelle B, Hardwigsen J, Le-Treut YP. Oxidative metabolism of bupivacaine into pipecolylxylidine in humans is mainly catalyzed by CYP3A. Drug Metab Dispos 2000;28(4):383-385.
50.- Venkatakrishnan K, Von Moltke LL, Greenblatt DJ. Human drug metabolism and the cytochromes P450: application and relevance of in vitro models. J Clin Pharmacol 2001;41(11):1149-1179.
2.- Challapalli V, Tremont-Lukats IW, McNicol ED, Lau J, Carr DB. Systemic administration of local anesthetic agents to relieve neuropathic pain. Cochrane Database Syst Rev 2005;(4):CD003345.
3.- Albright GA. Editorial: Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979;51(4):285-287.
4.- Heath ML. Deaths after intravenous regional anesthesia. Br Med J (Clin Res Ed) 1982;285(6346):913-914.
5.- Heath ML. Bupivacaine toxicity and Bier blocks. Anesthesiology 1983;59;(5):481.
6.- Guay J. Adverse events associated with intravenous regional anesthesia (Bier block): a systematic review of complications. J Clin Anesth 2009;21(8):585-594.
7.- Errando CL, Freijo JJ, Vila M, Tardón L. Toxicidad de los anestésicos locales. Prevención y tratamiento. Rev Esp Anestesiol Reanim 2013;60(Supl 1):65-72.
8.- Gristwood R, Bardsley H, Baker H, Dickens J. Reduced cardiotoxicity of levobupivacaine compared with racemic bupivacaine (Marcaine): new clinical experience. Exp Opin Invest Drugs 1994;3(11):1209-1212.
9.- Leone S, Di Cianni S, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaína and levobupivacaine. Acta Biomed 2008;79(2):92-105.
10.- Kopacz J, Allen HW. Accidental intravenous levobupivacaine. Anesth Analg 1999;89(4):1027-1029.
11.- Pirotta D, Sprigge J. Convulsions following axillary brachial plexus blockade with levobupivacaine. Anesthesia 2002;57(12):1187-1189.
12.- Khan H, Atanasoff PG. Accidental intravascular injection of levobupivacaine and lidocaine during the transarterial approach to the axillary brachial plexus. Can J Anaesth 2003;50(1):95.
13.- Salomäki TE, Laurila PA, Ville J. Successful resuscitation after cardiovascular collapse following accidental intravenous infusión of levobupivacaine during general anesthesia. Anesthesiology 2005;103(5):1095-1096.
14.- Lenfant F, Volot F, Freysz M, Wilkening M. Le flumazenil corrige-t-il les troubles de la conduction intracardiaque induits par l’injection intraveineuse accidentelle de bupivacaine? Ann Fr Anesth Réanim 1996;15(8):1196-1198.
15.- Karaca S, Ünlüsoy EÖ. Accidental injection of intravenous bupivacaine. Eur J Anaesthesiol 2002;19(8):616-617.
16.- Favier JC, da Conceiçao M, Fassassi M, Allanic L, Steiner T, Pitti R. Successful resuscitation of serious bupivacaine intoxication in a patient with pre-existing heart failure. Can J Anesth 2003;50(1):62-66.
17.- Fuzaylov G, Ying B, Tang Y, Sethnas NF. Successful resuscitation after inadvertent intravenous injection of bupivacaine in an adolescent. Pediatr Anesth 2010; 20(10):958-959.
18.- Gómez Arnau JI, Bartolomé A, García del Valle S, Puebla G, Santa Úrsula JA, Marzal JM, Arnal D, González A, González R. Errores de medicación y etiquetado de las jeringas. Rev Esp Anestesiol Reanim 2013;60(Supl 1):27-33.
19.- Telivuo L, Katz RL. The effects of modern intravenous local analgesics on respiration during partial neuromuscular block in man. Anaesthesia 1970;25(1):30-35.
21.- Moore DC, Batra MS. The components of an effective test dose prior to epidural block. Anesthesiology 1981;55(6):693-696.
22.- van Zundert A, Vaes L, Soetens M, de Vel M, van der Aa, van der Donck, Meeuwis H, de Wolf A. Every dose given in epidural analgesia for vaginal delivery can be a test dose. Anesthesiology 1987;67(3):436-440.
23.- Mulroy M, Neal JM, Mackey DC, Harrington BE. 2-chloroprocaine and bupivacaine are unreliable indicators of intravascular injection in the premedicated patient. Reg Anesth Pain Med 1998;23(1):9-13.
24.- Polaner DM, Zuk J, Luong K, Pan Z. Positive intravascular test dose criteria in children during total intravenous anesthesia with propofol and remifentanil are different than during inhaled anesthesia. Anesth Analg 2010;110(1):41-45.
25.- Mauch JY, Spielmann N, Hartnack S, Weiss M. Electrocardiographic and haemodynamic alterations caused by three different test solutions of local anaesthetics to detect accidental intravascular injection in children. Br J Anaesth 2012;108(2):283-289.
26.- Gieraerts R, van Zundert A, de Wolf A, Vaes L. Ten ml bupivacaine 0.125% with 12.5µg epinephrine is a reliable epidural test dose to detect inadvertent intravascular injection in obstetric patients. A double-blind study. Acta Anaesthesiol Scand 1992;36(7):656-659.
27.- Mather LE, Long GJ, Thomas J. The intravenous toxicity and clearance of bupivacaine in man. Clin Pharmacol Ther 1971;12(6):935-943.
28.- Groeben H, Schwalen A, Irsfeld S, Stieglitz S, Lipfert P, Hopf HB. Intravenous lidocaine and bupivacaine dose-dependently attenuate bronchial hyperreactivity in awake volunteers. Anesthesiology 1996;84(3):533-539. (PubMed) (pdf) (epub)
29.- Jorfeldt L, Löfström B, Pernow B, Persson B, Wahren J, Widman B. The effect of local anaesthetics on the central circulation and respiration in man and dog. Acta Anaesthesiol Scand 1968;12(4):153-169.
30.- Scott DB, Jebson PJR, Boyes RN. Pharmacokinetic study of the local anaesthetics bupivacaine (Marcain) and etidocaine (Duranest) in man. Br J Anaesth 1973;45(10):1010-1012.
31.- Scott DB. Evaluation of the toxicity of local anaesthetic agents. Br J Anaesth 1975;47(1):56-61.
32.- Wiklund L. Human hepatic blood flow and its relation to systemic circulation during intravenous infusion of bupivacaine or etidocaine. Acta Anaesth Scand 1977;21(3):189-199.
33.- Mather LE, Tucker GT, Murphy TM, Stanton-Hicks MA, Bonica JJ. Cardiovascular and subjective central nervous system effects of long-acting local anaesthetics in man. Anaesth Intensive Care 1979;7(3):215-221.
34.- Hasselstrom LJ, Mogensen T, Kehlet H, Christensen NJ. Effects of intravenous bupivacaine on cardiovascular function and plasma catecholamine levels in humans. Anesth Analg 1984;63(12):1053-1058.
35.- Sundberg A, Wattwil M, Wiklund L. Haemodynamic effects of intravenous bupivacaine during high thoracic epidural anaesthesia. Acta Anaesthesiol Scand 1987;31(2):143-147.
36.- Burm AG, de Boer AG, van Kleef JW, Vermeulen NP, de Leede LG, Spierdijk J, Breimer DD. Pharmacokinetics of lidocaine and bupivacaine and stable isotope labeled analogues: a study in healthy volunteers. Biopharm Drug Dispos 1988;9(1):85-91.
37.- Scott DB, Lee A, Fagan D, Bowler GMR, Bloomfield P, Lundh R. Acute toxicity of ropivacaína compared with that of bupivacaine. Anesth Analg 1989;69(5):563-569.
38.- Burm AGL, van der Meer AD, van Kleef JW, Zeijlmans PWM, Groen K. Pharmacokinetics of the enantiomers of bupivacaine following intravenous administration of the racemate. Br J Clin Pharmacol 1994;38(2):125-129.
39.- Groeben H, Schwalen A, Irsfeld S, Tarnow J, Lipfert P, Hopf HB. High thoracic epidural anesthesia does not alter airway resistance and attenuates the response to an inhalational provocation provocation test in patients with bronchial hyperreactivity. Anesthesiology 1994;81(4):868-874.
40.- Knudsen K, Beckman-Suurküla M, Blomberg S, Sjövall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaína, bupivacaine and placebo in volunteers. Br J Anaesth 1997;78(5):507-514.
41.- Litonius E, Tarkkila P, Neuvonen PJ, Rosenberg PH. Effect of intravenous lipid emulsion on bupivacaine plasma concentration in humans. Anaesthesia 2012;67(6):600-605.
42.- Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol 1998;46(3):245-249.
43.- Stewart J, Kellett N, Castro D. The central nervous system and cardiovascular effects of levobupivacaine and ropivacaína in healthy volunteers. Anesth Analg 2003;97(2):412-416.
44.- Owen MD, Gautier P, Hood DD. Can ropivacaine and levobupivacaine be used as test doses during regional anesthesia? Anesthesiology 2004;100(4):922-925.
45.- Hasselstrom LJ, Mogensen T. Toxic reaction of bupivacaine at low plasma concentration. Anesthesiology 1984;61(1):99-100.
46.- Tucker GT, Mather LE. Pharmacokinetics of local anesthetic agents. Br J Anaesth 1975;47suppl:213-224.
47.- Mather LE, Copeland SE, Ladd LA. Acute toxicity of local anesthetics: underlying pharmacokinetic and pharmacodynamic concepts. Reg Anesth Pain Med 2005;30(6):553-566.
48.- Scott DB. Toxic effects of local anaesthetic agents on the central nervous system. Br J Anaesth 1986;58(7):732-735.
49.- Gantenbein M, Attolini L, Bruguerolle B, Villard PH, Puyoou F, Durand A, Lacarelle B, Hardwigsen J, Le-Treut YP. Oxidative metabolism of bupivacaine into pipecolylxylidine in humans is mainly catalyzed by CYP3A. Drug Metab Dispos 2000;28(4):383-385.
50.- Venkatakrishnan K, Von Moltke LL, Greenblatt DJ. Human drug metabolism and the cytochromes P450: application and relevance of in vitro models. J Clin Pharmacol 2001;41(11):1149-1179.
Publicado
2014-03-31
Cómo citar
Gerónimo Pardo, M., Monsalve Naharro, J. Ángel, & López Pérez, A. (2014). Administración intencionada de bupivacaína /levobupivacaína intravenosa: revisión de la literatura. Caso clínico. Revista Electrónica AnestesiaR, 6(3), 2. https://doi.org/10.30445/rear.v6i3.216
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Revista Electrónica AnestesiaR by 