Neuropathy after bupivacaine (Marcaine) wrist and metacarpal nerve blocks

A series of 49 wrist and metacarpal blocks were done with the use of 0.25% or 0.5% bupivacaine in 44 patients for surgical and therapeutic purposes. Seven patients developed hypesthesia in the blocked nerve distribution lasting from 1 week to 4 months. One patient had pain and a positive Tinel sign in a dorsal branch of a digital nerve lasting 2 1/2 months. Since no neuropathies were reported in large series of nerve blocks with bupivacaine in other anatomic areas, it is postulated that bupivacaine in anatomically confined areas can cause a transient neuropathy possibly caused by a large local dose of the drug.