Page 487 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 26 Local Anesthetics 473

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C ASE STUD Y ANSWER

If a spinal anesthetic technique were selected, bupivacaine procedure, the potential for systemic toxicity would need to
would be an excellent choice. It has an adequately long be considered, making lidocaine or mepivacaine (generally
duration of action and a relatively unblemished record with epinephrine) preferable to bupivacaine (or even ropi-
with respect to neurotoxic injury and transient neurologic vacaine or levobupivacaine) because of their better thera-
symptoms, which are the complications of most concern peutic indexes with respect to cardiotoxicity. However, this
with spinal anesthetic technique. Although bupivacaine does not apply to epidural administration for postopera-
has greater potential for cardiotoxicity, this is not a concern tive pain control, which involves administration of more
when the drug is used for spinal anesthesia because of the dilute anesthetic at a slower rate. The most common agents
extremely low doses required for intrathecal administra- used for this indication are bupivacaine, ropivacaine, and
tion. If an epidural technique were chosen for the surgical levobupivacaine.