Bupivacaine and intravenous regional anaesthesia--a matter of controversy.

The role of bupivacaine in IVRA is controversial. It produces a reliable sensory and motor block and when used in larger doses prolonged residual analgesia is also achieved. Large series of its use without toxic complications have been presented. Yet, there are sporadic reports of severe, even fatal complications, usually as the result of a technical failure. In this article bupivacaine is compared to two other local anaesthetics commonly used in IVRA, i.e. lignocaine and prilocaine. Acidosis and hyperkaliemia are likely to increase the risk of bupivacaine toxicity. Other contributing factors include leakage under the tourniquet cuff and preexisting cardiac disease. We conclude that bupivacaine is a useful agent for IVRA assuming that the patients are carefully selected and the anaesthetist is aware of the possible risks and their prevention.