Bupivacaine 20mg/4ml (0.5%) / Glucose 320mg/4ml solution for injection ampoules

Bupivacaine is commonly used for spinal anaesthesia. The baricity of bupivacaine (isobaric vs. hyperbaric) may influence the spread, level of the block and the subsequent haemodynamic effects of the spinal anaesthesia. This review considers the available literature on the effect of baricity on the haemodynamic sequelae of spinal anaesthesia with bupivacaine. A literature search was conducted of the MEDLINE and EMBASE databases up to February 2024, following PRISMA guidelines. Randomised controlled trials (RCTs) comparing isobaric and hyperbaric bupivacaine in non-obstetric surgeries were included. Ten studies comprising 586 patients were included. While the literature suggests a trend towards greater incidence of hypotension with hyperbaric bupivacaine, no statistically significant difference was found. Variations in bupivacaine doses and volumes, spinal techniques and definitions of hypotension hindered definitive conclusions. Lower doses relevant to current practice also remain underexplored.

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Background/Objectives: Local anaesthetic systemic toxicity (LAST) is a rare but potentially fatal complication of dental and oral and maxillofacial surgical local anaesthesia (LA). Three amide agents are commonly used in the UK: lignocaine (lidocaine) 2% with adrenaline 1:80,000; articaine 4% with adrenaline 1:100,000 (2.2 mL cartridges); and bupivacaine 0.5%. Clinically significant discrepancies between guideline sources for maximum recommended dosages (MRDs) persist, and the additive toxicity of combined amide agents remains underappreciated. The objectives are: to provide clear, evidence-appraised MRD guidance for dental practitioners; to explain safe combination dosing using the fractional dose rule with acknowledgement of its pharmacokinetic limitations; and to outline recognition and management of LAST, including intravenous lipid emulsion (ILE) therapy, setting-stratified response, and differential diagnosis. Methods: These include the following: narrative review of MEDLINE (via PubMed), the Cochrane Library, and Embase (inception to May 2026), supplemented by key regulatory documents (British National Formulary (BNF) 91; US Food and Drug Administration (FDA) prescribing information; UK Summaries of Product Characteristics (SmPCs)); major guideline documents (American Society of Regional Anesthesia and Pain Medicine (ASRA) 2018; Association of Anaesthetists 2021; Resuscitation Council UK 2021); systematic reviews; and peer-reviewed literature, ranked by a jurisdiction-specific UK prescribing and regulatory source hierarchy. Results: BNF 91 and the FDA both support a 7 mg/kg (500 mg) MRD for lignocaine with adrenaline; in practice, the adrenaline ceiling limits administration to 6-7 cartridges (2.2 mL) regardless of the guideline followed. The principal reasons for caution when combining amide agents are; additive systemic toxicity, more complex dose calculation, absence of proven clinical benefit for concurrent mixing, unnecessary drug exposure, and incremental hypersensitivity risk-not metabolic pathway differences. The fractional dose rule is a pharmacologically justified safety heuristic with acknowledged pharmacokinetic limitations. ILE is a specific rescue therapy for severe or cardiovascular LAST; airway support and oxygenation remain the primary interventions. Patient-specific factors substantially lower the effective toxic threshold. Conclusions: Safe LA administration in oral surgery requires systematic MRD calculation, application of the fractional dose rule for combined-agent appointments, attention to patient-specific risk factors, setting-appropriate emergency preparedness, and structured differential diagnosis to distinguish LAST from more common dental emergencies.

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PurposeAlthough both perineural and intravenous dexamethasone have been shown to extend the analgesic duration of single-shot interscalene brachial plexus blocks (ISB), the optimal route of administration remains uncertain. This meta-analysis systematically compares the efficacy and safety of perineural versus intravenous dexamethasone as adjuvants to ISB in patients undergoing arthroscopic shoulder surgery.MethodsPrimary outcomes assessed were analgesia duration, sensory block duration, and motor block duration. Secondary outcomes included postoperative pain scores, opioid consumption, and the incidence of adverse events, such as local anesthetic systemic toxicity (LAST). We systematically searched PubMed, Embase, and Web of Science from inception to May 31, 2021 under a prespecified protocol; studies published thereafter were beyond the scope of this review.ResultsA total of seven studies involving 846 patients were included in this analysis. Compared with intravenous administration, perineural injection of dexamethasone significantly prolonged analgesia duration (weighted mean difference WMD: 1.699 h; 95% confidence interval CI: 0.014-3.384; p = 0.048) and reduced postoperative pain scores at 12 h (WMD: -0.652; 95% CI: -1.129 to -0.176; p = 0.007). No significant differences were observed in sensory or motor block durations, postoperative pain scores, and opioid consumption at 24 h, or the incidence of adverse events, including dyspnea, sleep disturbances, and postoperative glucose level fluctuations.ConclusionsCompared with the intravenous route, perineural dexamethasone modestly prolongs the duration of analgesia after single-shot interscalene block (approximately 2 h). However, the associated reductions in postoperative pain scores are small and unlikely to reach commonly cited MCID thresholds, rendering the overall clinical importance uncertain. These findings support cautious interpretation and individualized route selection rather than generalized claims of superiority.

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BackgroundThis study assessed the effect of perineural dexamethasone on block duration, opioid requirement, blood glucose levels, and stress response to surgery as measured by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), following pediatric foot and ankle surgery.MethodsIn this parallel, double-blinded randomized controlled trial, 90 children (ages 2-5 years, >5 kg) scheduled for foot or ankle surgery under spinal anesthesia with ultrasound-guided single-shot popliteal sciatic nerve block were randomized into 3 groups: 0.5% ropivacaine with saline (control), 0.5% ropivacaine plus dexamethasone 0.1 mg/kg (DEX0.1), and 0.5% ropivacaine plus dexamethasone 0.05 mg/kg (DEX0.05). Primary outcome was the time to first rescue opioid analgesia. Secondary outcomes included motor block duration, pain scores, NLR, PLR, and blood glucose levels.ResultsTime to first rescue opioid analgesia was significantly longer in the DEX0.1 group compared with the DEX0.05 group (18.4 hours, SD 2.6 hours vs 16 hours, SD 2.8 hours), with a mean difference of 2.2 hours (95% CI 0.7 to 3.6), pConclusionsPerineural dexamethasone significantly prolonged postoperative motor block duration and did not influence blood glucose, NLR, or PLR levels.Trial registration numberNCT06086418.

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Laparoscopic gynecological surgery, while minimally invasive, is frequently associated with significant postoperative pain requiring systemic analgesics. Local anesthetic administration, either intraperitoneally or at trocar sites, has been proposed to improve analgesia and recovery, but evidence remains inconsistent. To evaluate and compare the efficacy of intraperitoneal and port-site local anesthetic injection versus placebo in reducing postoperative pain and improving recovery outcomes in women undergoing gynecological laparoscopic surgery. This randomized, double-blind, three-arm controlled trial enrolled 90 women aged 18-60 years undergoing elective gynecological laparoscopy at Kasr Al-Ainy Hospital, Cairo, Egypt (March 2024-March 2025; ClinicalTrials.gov NCT07030647). Participants were randomized into: Group A (trocar site bupivacaine 0.25%), Group B (intraperitoneal bupivacaine 0.25%), and Group C (saline placebo). Postoperative pain was assessed using a visual analog scale (VAS) at 1, 6, 12, and 24 h. Secondary outcomes included rescue diclofenac use, time to first analgesic, total diclofenac dose, time to ambulation, hospital stay, and patient satisfaction. Baseline demographics were comparable across groups. Group B reported the lowest pain scores at 1, 6, and 12 h (0.1 ± 0.3; 2.9 ± 1.1; 2.1 ± 0.3, respectively), followed by Group A, while Group C had the highest (p < 0.001). At 24 h, pain scores were similar (p = 0.087). Diclofenac requirement was significantly reduced in Group B (26.7%) compared to Groups A (83.3%) and C (100%) (p < 0.001). Time to first rescue analgesic was longest in Group B (7.1 ± 1.1 h vs. 2.9 ± 0.7 and 1.5 ± 0.8; p < 0.001). Total 24-hour diclofenac consumption was lowest in Group B (75 mg) versus Groups A (114 ± 38.2 mg) and C (142.5 ± 22.9 mg; p < 0.001). Early ambulation occurred fastest in Group B (3.5 ± 0.9 h), followed by Group A (5.1 ± 0.6 h) and Group C (6.9 ± 0.8 h; p < 0.001). Hospital stay was 24 h in all groups. Patient satisfaction was highest in Group B (7.3 ± 1.2), intermediate in Group A (4.2 ± 1.6), and lowest in Group C (3.0 ± 0.8; p < 0.001). Both intraperitoneal and trocar site local anesthetic administration significantly reduced postoperative pain and analgesic requirements compared with placebo. Intraperitoneal administration demonstrated superior efficacy, leading to earlier ambulation and higher patient satisfaction. Routine use of intraperitoneal local anesthetic may enhance postoperative recovery in gynecological laparoscopy.Trial registration ClinicalTrials.gov Identifier: NCT07030647 (retrospectively registered 20 June 2025).

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BackgroundPatients undergoing foot and ankle surgery often experience severe postoperative pain. This study aimed to assess the efficacy of liposomal bupivacaine for popliteal sciatic and saphenous nerve blocks in managing pain after foot and ankle surgery.MethodsThe study was registered with the Chinese Clinical Trial Registry (ChiCTR2400088305) and received ethical approval from the Institutional Review Board of Xuzhou Renci Hospital (XZRCLL-KT-202407003). In this randomized trial, 142 patients undergoing elective foot/ankle surgery received popliteal-sciatic and saphenous nerve blocks with either 50 mg ropivacaine (R group) or 133 mg liposomal bupivacaine (L group). Primary outcome was postoperative sufentanil consumption; secondary outcomes included analgesia duration, motor blockade, recovery quality, sleep quality, and adverse events.ResultsCompared with Group R, Group L demonstrated significantly lower sufentanil consumption at 12 h, 24 h, 48 h, and 72 h postoperatively (all p p p ConclusionThe administration of liposomal bupivacaine for popliteal sciatic and saphenous nerve blocks significantly reduces postoperative opioid consumption and extends nerve block duration, providing a safe and effective technique for postoperative analgesia in patients undergoing foot and ankle surgery. Preoperative sleep quality, surgical type, and Pain Catastrophizing Scale score are independent predictors of the pain trajectory that can identify patients more likely to benefit from liposomal bupivacaine.Clinical trial registrationhttps://www.chictr.org.cn, Identifier ChiCTR2400088305.

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BackgroundThe optimal analgesia regimen for patients undergoing laparoscopic gastrectomy is still unclear. This study evaluated the efficacy of ultrasound-guided rectus sheath block (RSB) with liposomal bupivacaine in providing sustained and effective analgesia to enhance recovery after laparoscopic gastrectomy.MethodsThe study population comprised 102 individuals who underwent randomization to receive a rectus sheath block with one of the following: Ropivacaine-Dexamethasone (RD group), Liposomal Bupivacaine (LB group), or Liposomal Bupivacaine-Dexamethasone (LBD group). The primary efficacy measure was defined as total opioid consumption (within 72 hour postoperative), converted to morphine milligram equivalents (MME). Secondary outcomes included pain scores at rest and during movement (within 72 hours postoperatively), QoR-15-based recovery quality, perioperative satisfaction, inflammatory biomarker levels (preoperative, 24h and 72h postoperatively), PACU/hospital stay duration, and adverse events.ResultsThe RD group had significantly higher total opioid consumption compared with the LB group and the LBD group. The LB group and the LBD group had significantly lower pain scores at rest and on movement at 12 h, 24 h, and 48 h after surgery, when compared with the RD group. The LB group and the LBD group had lower concentrations of Interleukin-1β (IL-1β) and interleukin-6 (IL-6) at 24 h compared with the RD group. In addition to reporting significantly better QoR-15 scores in the initial 48 hours, patients receiving liposomal bupivacaine (with or without dexamethasone) also experienced lower rates of PONV compared to the ropivacaine-dexamethasone cohort. Furthermore, there were no statistically significant differences between the three groups regarding length of post-anesthesia care unit stay, perioperative satisfaction, and length of hospital stay. There were no statistical differences between the LB group and the LBD group in all data. And the addition of dexamethasone to LBD provided no additional benefit over liposomal bupivacaine alone LB.ConclusionIn conclusion, ultrasound-guided rectus sheath block with liposomal bupivacaine provided superior analgesia and reduced opioid consumption for up to 48 hours compared with a ropivacaine-dexamethasone regimen in patients undergoing laparoscopic gastrectomy. However, the addition of perineural dexamethasone to liposomal bupivacaine did not confer further analgesic benefit.Trial registrationwww.chictr.org.cn: Identifier: ChiCTR2500098338.

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ObjectiveTo examine how patients having open heart surgery under cardiopulmonary bypass (CPB) react to surgical stress following bilateral transversus thoracis plane (TTP) block with ropivacaine improved by dexmedetomidine (DEX).MethodsThree groups of sixty patients (26M/34F, ASA II-III, 18-65 years old) slated for elective CPB heart surgery were randomly assigned: general anesthesia alone (Group C), TTP (ropivacaine) combined with general anesthesia group (Group R), or TTP (ropivacaine + DEX) combined with general anesthesia group (Group RD). Primary outcomes measured serum cortisol levels at five perioperative phases, while the secondary outcomes included glucose/C-reactive protein (CRP) levels, Numeric Rating Scale (NRS) pain scores postextubation, 48-hr sufentanil consumption, patient-controlled analgesia (PCA) demand frequency, rescue analgesia rates, mechanical ventilation duration, ICU stay, and complications.ResultsAt 24 h postoperatively, RD and R groups exhibited statistical lower serum cortisol levels compared to controls (p p p = 0.031). However, no intergroup differences occurred pulmonary complications.ConclusionDEX-enhanced TTP blockade may contribute to attenuating the stress response, optimizing analgesia, and improving early postoperative recovery parameters in CPB cardiac surgery through opioid-sparing mechanisms and sympatholytic effects, demonstrating clinical viability within Enhanced Recovery After Surgery (ERAS) protocols.Clinical trial registrationhttps://www.chictr.org.cn/index.html, identifier ChiCTR2400085899.

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