[Toxicity of prilocaine and bupivacaine in intravenous regional anesthesia].
In a prospective randomized study plasma levels of prilocaine and bupivacaine were analyzed after intravenous regional analgesia (IVRA). 20 patients respectively received either 1 mg/kg bupivacaine or 4 mg/kg prilocaine in an equipotent dosis. Prilocaine proved to be significantly less toxic than bupivacaine. Plasma levels of bupivacaine, expressed as percentage of the toxic limit, were threefold higher than those of prilocaine. In one case the maximum level of bupivacaine reached even 85% of the toxic limit. This demonstrates the possibility of dangerous side effects when exceeding the bupivacaine dose of 1 mg/kg. Methaemoglobin formation following use of prilocaine was of no clinical importance. Prilocaine is the agent of choice for intravenous regional analgesia. The use of bupivacaine for IVRA should be limited to special indications.
D000328:Adult; D000765:Anesthesia, Conduction; D002045:Bupivacaine / Q000009:adverse effects* / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008706:Methemoglobin / Q000378:metabolism; D011318:Prilocaine / Q000009:adverse effects* / Q000097:blood; D011446:Prospective Studies; D011897:Random Allocation
D011318:Prilocaine; D008706:Methemoglobin; D002045:Bupivacaine
Toxizität von Prilocain und Bupivacain in der intravenösen Regionalanästhesie.