[The problem of the cardiotoxicity of bupivacaine 0.75%]

A survey of American publications on the problem of cardiotoxicity of bupivacaine 0.75% is given. It can easily be demonstrated that all investigations were done on animals. Furthermore the dosages used in these investigations are far above those which are applied in humans. It seems to be rather obvious that with increasing emotional discussions of the problem of bupivacaine 0.75% the conclusions of the investigators are becoming more and more "defensive". Even the same group of investigators who dealt with the problem previously explain their results more cautiously 3 or 4 years later! Besides these investigations some of the more positive publications of the last 2 or 3 years are discussed. Finally it is pointed out that all clinical or experimental investigations on humans did not show any negative results when bupivacaine 0.75% was used. Careful application and a dose of not more than 2 mg per kg body weight are mandatory. With this in mind there seems to be no justified reasons to withdraw bupivacaine 0.75% from the market. Finally recommendations for correct application of bupivacaine 0.75% for epidural anaesthesia in obstetrics and surgery are given.