Bupivacaine for Tumescent? John Mauriello, MD, FACPh responds!

January 12, 2011 - Thanks Dr. Maruiello for sharing your expertise!

I am most appreciative to you, ron, and to dr. mauriello for the very helpful and prompt assistance
i spent many hours online researching this without finding any useful specific information and dr. mauriello provided it succinctly and authoritatively

thanks to all !

Richard Mueller, MD, FACC, FACP, FAHA

 

_________________________________________________

January 11, 2011- John Mauriello, MD, FACPh responds!

In my opinion bupivacaine (Sensorcaine^® Marcaine^®) has a poor profile when it comes to toxicity. It’s the only local anesthetic that will stop the heart before stopping respiration. As such, I have never used it for tumescent anesthesia.  With a true lidocaine toxicity mepivacaine (Polocaine^® Carbocaine^®) is the local anesthetic of choice. There is no cross sensitivity between the amide local anesthetics. It can also be used without epinephrine (for patients who are sensitive to epinephrine) since it is longer acting then lidocaine and the addition of epinephrine does not significantly  prolong anesthesia with mepivacaine. I add 50 ml of 2 % mepivacaine to a 500 ml bag of NS with 5 ml of 8.4% Sodium Bicarbonate. This gives you 555 ml of 0.18% mepivacaine. Don’t use more than this bag (555 ml). Remember if there is any doubt, especially in a patient with multiple allergies, you can always have the patient tested before the procedure 

Reference. FUNDAMENTALS OF PHLEBOLOGY: VENOUS DISEASE FOR CLINICIANS. 2^nd  edition. Royal Society of Medicine Press.  pg 125-136.

 John Mauriello, MD, FACPh

Vein Center at Batey Cardiovascular
6100 Pointe West Blvd.
Bradenton, FL 34209
941-798-3840
Fax 794-3659
www.veinscenter.com 

_______________________________

Reponse