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Anesth Analg 1983; 62:796-801
© 1983 International Anesthesia Research Society
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Evaluation of the Myotoxicity of Bupivacaine in Bier Blocks—A Biochemical and Electron Microscopic Study

Eija A. Kalso, MD, Martti L. Lalla, MD, Per H. Rosenberg, MD, Marjatta K. Tuominen, MD, Seppo Santavirta, MD, and Johan Gripenberg, MD

Department of Anesthesiology, Surgical Hospital, Helsinki University Central Hospital, SF-00130 Helsinki 13, Finland.

Abstract

The possible myotoxic effect of bupivacaine in combination with tourniquet ischemia was evaluated in 11 patients who underwent surgery of an arm under intravenous regional anesthesia. Eleven patients with the same kind of surgery and tourniquet who had general anesthesia served as controls. Venous blood bupivacaine concentrations in the anesthetized arm were high at the end of tourniquet time (27.2–202 µg/ml) and varied from 2.3 to 12.3 µg/ml 10 min after tourniquet release. Changes in blood-gas tensions and plasma potassium and lactate concentrations before and just after tourniquet release correlated with the ischemia time. Changes in creating phosphokinase, lactate dehydrogenase and aspartate aminotransferase activities, possible indices of loss of integrity of muscle cell membranes, varied considerably and did not correlate with the ischemia time. There were no significant differences between the two groups in any of the parameters. Electron microscopy revealed no evidence of muscle degeneration 24 hr after the use of tourniquet with either bupivacaine intravenous regional (n = 4) or general anesthesia (n = 3).

Key Words: ANESTHETIC, Local: bupivacaine • ANESTHETIC TECHNIQUES, Intravenous regional • TOXICITY: local anesthetics






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1983 by the International Anesthesia Research Society.