Best indications for local anaesthetics: bupivacaine

Bupivacaine is a local anaesthetic of great potency and long duration but has also well known cardio-and CNS toxic side-effects. For many years it was nearby the only local anaesthetic with these characteristics, making it applicable to almost all kind of loco-regional anaesthetic techniques, and still nowadays, for economical reasons it is in many occasions the only alternative available. In this review, departing from analysis of the physical, chemical and pharmacological properties of this molecule and considering also its toxic potencies we wanted to analyze all clinical situations in which it is used. But above all we have reviewed the most recent international literature, which are actually the best indications for this drug, that in the last years with the appearance of first ropivacaine and then levobupivacaine, seemed to have lost its field of elective application. According to these analysis we concluded that this drug, though still remaining a good alternative in many fields of loco-regional anaesthesia (like peripheral blocks), as well as an efficient drug equal to the above mentioned ones in any sector like epidural analgesia in caesarean section, its best indication is subarachnoideal anaesthesia (combined and not) where it is the best available drug in hyperbaric solution without doubts. It might be interesting in the next future the comparison with hyperbaric solutions of levobupivacaine (not yet available).