Let's talk about accidental intravascular administration of Bupivacaine . Let me be very clear, It could be fatal. Be very careful when using bupivacaine during spinal or epidural anaesthesia. Cardiac resuscitation after bupivacaine intravascular injection could be very very difficult. Pregnancy and hypoxia and acidosis and bupivacaine are lethal combination.
Let me explain, Why bupivacaine is so different in its effects compared to lignocaine? The lipid solubility is much more and the drug has very slow dissociation from the cardiac sodium channels. Which means, it goes in fast but comes out very slowly. Hence, if you see blood in the syringe while injecting bupivacaine during spinal or epidural Never inject it. And yes, never use it in any concentration more than 0.25 percent while giving epidural analgesia.
