Eladur (bupivacaine) / Durect, Amneal - LARVOL DELTA

Intrathecal bupivacaine versus bupivacaine plus fentanyl for anaesthesia for Caesarean delivery: a randomised double-blind noninferiority trial. (PubMed, Br J Anaesth) - P1 | "Under the condition of this study, use of a higher dose of intrathecal bupivacaine was noninferior to bupivacaine plus fentanyl for providing effective anaesthesia for Caesarean delivery. Use of bupivacaine alone for spinal anaesthesia for Caesarean delivery can be considered when adding fentanyl is not desired or not feasible."

Head-to-Head • Journal • Anesthesia • Dermatology • Hypotension • Pain • Pruritus

Effectiveness of Regional Anesthesia Techniques in Reducing Perioperative Analgesia Consumption for Cesarean Delivery: A Scoping Review (ASA 2025) - "Included studies (n = 244) encompassed various regional anesthesia techniques such as transversus abdominis plane (TAP) blocks, ilioinguinal nerve blocks, and neuraxial adjuncts like intrathecal bupivacaine with opioids or adjuvants...Notably, studies comparing bupivacaine with adjuvants (e.g., buprenorphine, fentanyl, magnesium sulfate) observed improved analgesic effects, though with variable impacts on opioid-sparing benefits. Reduction in total opioid consumption was reported in experimental groups; however, inconsistencies in morphine-equivalent reporting hinder direct comparisons across studies...Regional anesthesia techniques play a crucial role in perioperative pain management for cesarean deliveries, demonstrating potential in prolonging analgesia and reducing opioid requirements. However, variations in study methodologies, inconsistent opioid quantification, and limited long-term outcome data highlight the need for further research with standardized reporting..."

Review • Anesthesia

Intrathecal bupivacaine dose in spinal anaesthesia for prevention of pain during caesarean delivery - the "white elephant" in the guidelines - in response to "Shedding more light on the management of intraoperative pain during cesarean delivery: a review of the American Society of Anesthesiologists statements.". (PubMed, Int J Obstet Anesth) - No abstract available

Journal • Anesthesia • Pain

Serotonin syndrome following spinal anaesthesia for elective caesarean delivery: a case report. (PubMed, Int J Obstet Anesth) - "The patient, who was taking sertraline at the time of anaesthesia, developed pyrexia, diaphoresis, spontaneous rigidity, episodes of arrhythmias, became unresponsive and went into peri-arrest. We postulate plausible mechanisms, including the role of opioids, intrathecal bupivacaine, and acute stress that may have contributed to the onset of serotonin syndrome. The case underscores the importance of early identification of serotonin syndrome and its presentation in obstetric patients."

Journal • Anesthesia • Cardiovascular • Obstetrics

Comparative efficacy of hyperbaric bupivacaine vs hyperbaric ropivacaine in spinal anesthesia for cesarean section: A meta-analysis. (PubMed, World J Methodol) - "This meta-analysis offers insights into the effectiveness and safety of hyperbaric bupivacaine vs ropivacaine for cesarean sections. Hyperbaric ropivacaine had a comparable safety profile and faster regression of sensory and motor blockade than hyperbaric bupivacaine, perhaps aiding early mobilization of parturient and facilitating mother-child bonding. Choosing ropivacaine may offer benefits beyond efficacy for cesarean section patients and short surgical procedures."

Journal • Retrospective data • Anesthesia • Hypotension • Pain

Pregnancy protects nervous tissues against the neurotoxicity of intrathecal bupivacaine in rabbits. (PubMed, Neurotoxicol Teratol) - "These findings suggest that pregnancy confers a protective effect on nervous tissue against the neurotoxicity induced by intrathecal bupivacaine."

Journal • Preclinical • Anesthesia • Obstetrics

Minimal dose, maximum safety: continuous spinal and peripheral nerve blocks for femur surgery in a high-risk patient (Euroanaesthesia 2025) - "Premedication included 50mcg fentanyl and 1mg midazolam. Ultrasound-guided femoral and lateral femoral cutaneous nerve blocks were performed with 75mg ropivacaine (20mL 0,375%)...2 hours into surgery, perineal discomfort due to limb traction prompted an additional 1mg intrathecal bupivacaine, 20mcg IV fentanyl and 1g paracetamol. The patient remained hemodynamically stable throughout and after surgery, requiring no vasopressor support, and was discharged 4 days later without complications, including no post-dural puncture headache. Timely hip fracture repair is essential for improving outcomes, and this case underscores the value of combining CSA with PNBs to provide a tailored approach for frail patients with multiple comorbidities, thereby minimizing the risk of hemodynamic instability."

Clinical • Surgery • Anemia • Anesthesia • Asthma • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Coronary Artery Disease • Hematological Disorders • Hypertension • Immunology • Migraine • Musculoskeletal Diseases • Nephrology • Orthopedics • Pain • Pulmonary Arterial Hypertension • Pulmonary Disease • Renal Disease • Respiratory Diseases

Comparison of buprenorphine as adjuvant to intrathecal bupivacaine vs no adjuvants for lower limbs peripheral vascular disease reconstruction surgeries (Euroanaesthesia 2025) - "Higher incidence of PONV was in GB 4(13,33%) compare to GA 3 (10%) and was not SD. Urinary retention level was greater in GB 3 (10%) than in GA 2(6,67%).Conclusion(s): Addition of 60mcg of buprenorphine to intrathecal bupivacaine prolonged the duration and quality of postoperative analgesia after Lower Limbs Peripheral Vascular Disease Reconstruction Surgeries with minimal adverse effects like urinary retention and PONV which were not significant to hinder recovery."

Clinical • Surgery • Anesthesia • Cardiovascular • Pain • Peripheral Arterial Disease

The effect of adding intrathecal Ketamine to spinal anaesthesia on post operative pain in patients undergoing major colorectal surgical procedures (Euroanaesthesia 2025) - "[3] This study investigates the impact of adding intrathecal ketamine to spinal anaesthesia for post-op pain management in patients undergoing major colorectal surgical procedures, with a focus on postoperative opioid consumption. A retrospective chart review was conducted on patients who received either intrathecal bupivacaine and morphine or a combination of intrathecal bupivacaine, morphine, and ketamine, June 2023 to September 2024. The addition of intrathecal ketamine to spinal anaesthesia may offer a valuable adjunct in postoperative pain management, aligning with multimodal analgesia principles and ERAS protocols. Future prospective studies are warranted to validate these results to enhance outcomes in colorectal surgery patients."

Clinical • Anesthesia • Hypotension • Pain

Acute Cauda Equina Syndrome Following Spinal Anesthesia During Cesarean Section: A Case Report. (PubMed, Acta Neurol Taiwan) - "This case report aims to discuss the prompt recognition and the possible mechanism of acute cauda equina syndrome (CES) following intrathecal bupivacaine administration for cesarean section...Understanding the potential mechanisms underlying bupivacaine-induced neurotoxicity, including direct nerve toxicity, vascular changes, and synergistic effects, may guide the development of targeted therapeutic strategies to mitigate this devastating complication. Early spinal imaging, high-dose steroid therapy, and a collaborative approach involving obstetrics, anesthesiology, neurology, and rehabilitation services are crucial for the successful management of acute CES."

Journal • Anesthesia • CNS Disorders • Obstetrics

Analgesic effects of intrathecal bupivacaine with neostigmine or morphine among elective surgical patients in selected comprehensive specialised hospitals, Southern Ethiopia: a prospective cohort study. (PubMed, BMJ Open) - "Compared with BG, MG and NG had longer-lasting postoperative analgesic effects, less severe pain and required fewer analgesics overall. Patients in the NG had more incidences of nausea and vomiting. The incidences of pruritus and respiratory depression were highest in the MG. Effective analgesia appeared to work better in the MG and NG. We recommend morphine and neostigmine as adjuvants to local anaesthetics for effective postoperative analgesia. We also recommend researchers compare different doses of neostigmine and morphine as adjuvants to bupivacaine in further studies."

Clinical • Journal • Anesthesia • CNS Disorders • Depression • Dermatology • Obstetrics • Pain • Pruritus • Psychiatry

INTRATHECAL DEXMEDETOMIDINE IN CESAREAN SECTION SPINAL ANESTHETICS AND POST OPERATIVE PAIN SCORES; A RETROSPECTIVE REVIEW (ASRA-SPRING 2025) - "Due to drug and nursing staffing shortages, a community hospital’s standard cesarean anesthetic was intrathecal bupivacaine with no adjuvants...Secondary outcomes included morphine milligram equivalents (MME), intraoperative mean arterial pressure, postoperative mean arterial pressure (MAP) and infant APGARs...However, patients receiving 10 ug intrathecal dexmedetomidine had higher incidences of intraoperative and postoperative hypotension. This may be a dose dependent effect (4) but warrants caution before using intrathecal dexmedetomidine routinely."

Retrospective data • Review • Addiction (Opioid and Alcohol) • Anesthesia • Hypotension • Obstetrics • Pain

CONTINUOUS SPINAL ANESTHESIA FOR TOTAL KNEE ARTHROPLASTY REVISION IN A PATIENT WITH SEVERE PULMONARY HYPERTENSION (ASRA-SPRING 2025) - "Surgery lasted 4.5 hours, requiring additional intrathecal bupivacaine boluses. The patient received judicious dexmedetomidine, midazolam, and fentanyl for anxiolysis and analgesia...He was transitioned from enoxaparin back to warfarin, and his recovery was uneventful...However, CSA carries risks of post-dural puncture headache and cauda equina syndrome, the latter being primarily linked to microcatheters and hyperbaric local anesthetics. In summary, CSA can be a suitable anesthetic choice for PH patients undergoing major lower extremity orthopedic surgery, balancing effective anesthesia with minimized risks, provided that careful monitoring and management are ensured."

Clinical • Anesthesia • Cardiovascular • Congestive Heart Failure • Genetic Disorders • Heart Failure • Infectious Disease • Obesity • Obstructive Sleep Apnea • Orthopedics • Pain • Pulmonary Arterial Hypertension • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Sleep Disorder

Comparison of intrathecal bupivacaine with tramadol and bupivacaine with dexamethasone for post cesarean section pain relief extension in elective cesarean sections under spinal anesthesia in resource limited setup: prospective observational study. (PubMed, Ann Med Surg (Lond)) - "As a result, numerous adjuvants were added to local anesthetics, including epinephrine, phenylephrine, clonidine, opioids, dexamethasone, tramadol, and so on...The total analgesia requirement within 24 hours for diclofenac, tramadol, morphine, and pethidine were analyzed and there was a statistically significant difference among the groups with all anti pains, P < 0.05...It revealed that the B-D group (mean time in minutes, 110.6 [95% CI, 106.3-120.4]; P = 0.02) had a shorter mean time to first rescue analgesic administration than the B-T group (mean time in minutes, 136.6 [95% CI, 123.6-142.5]; P = 0.02). This study found that using tramadol as an adjuvant with bupivacaine for intrathecal route significantly extended duration of pain-free period after subarachnoid anesthesia, as compared to 4 mg dexamethasone added to intrathecal bupivacaine."

Journal • Observational data • Anesthesia • Obstetrics • Orthopedics • Pain

Empirical pharmacodynamic model of phenylephrine and intrathecal bupivacaine for mean arterial pressure prediction in obstetric patients presenting for elective cesarean delivery under spinal anesthesia. (PubMed, J Clin Monit Comput) - "Similar performance was observed on independent validation using a second dataset (N = 84), yielding an RMSE of 4.2 ± 1.6 mmHg for one-minute ahead MAP predictions. Our ARX model showed good performance at up to a three-minute prediction horizon and could be used for future decision support applications to guide phenylephrine dose titration."

Journal • PK/PD data • Anesthesia • Hypotension • Obstetrics • Preventive care

Comparison of Buprenorphine as Adjuvant to Intrathecal Bupivacaine vs no Adjuvants for Lower Limbs Peripheral Vascular Disease Reconstraction Surgeries (IARS-SOCCA 2025) - "Addition of buprenorphine to intrathecal bupivacaine prolonged the duration and quality of postoperative analgesia after Lower Limbs Peripheral Vascular Disease Reconstraction Surgeries. The dose of buprenorphine from 60mcg provided longer duration of analgesia with minimal adverse effects like urinary retention and PONV which were not significant to hinder recovery."

Clinical • Surgery • Anesthesia • Cardiovascular • Diabetes • Hypotension • Immunology • Metabolic Disorders • Pain • Peripheral Arterial Disease

Anesthetic Management for Cesarean Section in a Patient with Spondyloepimetaphyseal Dysplasia and Pierre Robin Syndrome: A Case Report and Scoping Review of Neuraxial Anesthesia in Dwarfism (IARS-SOCCA 2025) - "A total of 7.5mg of 0.75% bupivacaine, 50μg of preservative-free morphine, and 25μg of fentanyl were injected intrathecally...In this review, we highlight the most common neuraxial technique, the prevalence of each NA technique seen in the literature, ranges of intrathecal bupivacaine and epidural lidocaine, and mean dosages of local anesthetic used.Overall, a reduced dose of local anesthetic was commonly administered for both intrathecal and epidural anesthesia to account for the patients' altered spinal anatomy with limited complications reported... This case report and scoping review highlights the importance of individualized dosing strategies and careful monitoring when administering neuraxial anesthesia in patients with altered spinal anatomy such as SEMD and achondroplasia. Our tailored anesthetic plan supported by previous cases reported in the literature resulted in effective anesthesia with minimal complications, underscoring the feasibility and safety of..."

Case report • Clinical • Review • Anesthesia • Endocrine Disorders • Genetic Disorders • Obstetrics • Orthopedics

Anesthetic Management of Parturients With Achondroplasia During Labor and Delivery: A Narrative Review. (PubMed, Anesth Analg) - "Reduced dose of intrathecal bupivacaine was common in this population...Neuraxial anesthesia is more common and a viable option in carefully selected parturients with achondroplasia. We recommend reduction of intrathecal local anesthetic as part of a titratable neuraxial technique (ie, combined spinal-epidural) that minimizes the risk of hypotension, high spinal, and emergent intubation."

Journal • Anesthesia • Endocrine Disorders • Genetic Disorders • Hypotension

Effects of 4 mg and 8 mg Dexamethasone Added to Intrathecal Bupivacaine on Perioperative Analgesia Among Adult Orthopedic Patients at Sodo Christian Hospital: A Prospective Cohort Study. (PubMed, Pain Res Manag) - "The addition of dexamethasone did not result in any issues, nor was there a statistically significant difference in the onset time between the two groups. Dexamethasone at a dose of 4 mg extends the duration of sensory, motor, and overall analgesia in a manner similar to that of 8 mg dexamethasone with comparable durations for both the initial analgesic request and overall analgesic use."

Clinical • Journal • Anesthesia • Orthopedics • Pain

Combined spinal-epidural vs. dural puncture epidural techniques for labour analgesia: a randomised controlled trial. (PubMed, Anaesthesia) - "There were no significant differences in the quality of labour analgesia following initiation of a combined spinal-epidural compared with a dural puncture epidural technique."

Journal • Anesthesia • Pain

Safety verification of high-dose intrathecal baclofen in rats (ASA 2024) - "Using the same experimental protocol, we previously reported that intrathecal bupivacaine at more than 4% (i.e., eight times higher than the highest recommended clinical concentration) induced histological damage to the posterior root and posterior column in rats (2). Conversely, intrathecal bupivacaine used at clinical concentrations is safe. The present results showed that baclofen is safe even at 12000 μg/ml (i.e., 20 times higher than the highest recommended clinical concentration)."

Preclinical • Movement Disorders • Musculoskeletal Pain • Neuralgia • Pain

Comparative Analysis of Intrathecal Bupivacaine With Fentanyl Versus Intrathecal Bupivacaine With Midazolam in Lower Abdominal and Lower Limb Surgeries. (PubMed, Cureus) - "Also, Group F had a significantly longer duration of effective analgesia compared to Group M (266 ± 15.9 vs. 197.6 ± 13.7 minutes). The addition of 0.5 ml (2.5 mg) Midazolam with 0.5% hyperbaric Bupivacaine intrathecally prolonged the duration of anaesthesia and postoperative analgesia; however, fentanyl 0.5 ml (25 mcg) has a more prolonged duration of intraoperative and postoperative analgesia."

Journal • Surgery • Anesthesia

Simulated bupivacaine pharmacokinetics after labor epidural analgesia followed by transversus abdominis plane block with liposomal bupivacaine for intrapartum cesarean delivery. (PubMed, J Clin Anesth) - "Across 6 different simulations of TAP blocks for intrapartum CD analgesia, LEA with bupivacaine (with or without boluses for extension and including a conservative modeling of lidocaine without epinephrine), followed by TAP block with LB and/or bupivacaine hydrochloride 0, 1, or 2 h after CD, is unlikely to result in bupivacaine plasma concentrations reaching local anesthetic systemic toxicity thresholds in healthy patients."

Journal • PK/PD data • Anesthesia • Cardiovascular

Is intrathecal bupivacaine plus dexmedetomidine superior to bupivacaine in spinal anesthesia for a cesarean section? A systematic review and meta-analysis. (PubMed, Eur Rev Med Pharmacol Sci) - "Use of intrathecal dexmedetomidine for spinal anesthesia in cesarean section significantly prolongs sensory and motor block compared to using bupivacaine alone as an adjuvant. It also improves analgesia after 1 hour with no difference in the incidence of maternal and neonatal adverse effects compared to bupivacaine alone. The optimal dose of dexmedetomidine to use remains to be ingested."

Clinical • Journal • Retrospective data • Review • Anesthesia • Pain

Assessment of the Efficacy of Nalbuphine as an Adjuvant to Intrathecal Bupivacaine in Endoscopic Urological Surgeries for the Prolongation of Postoperative Analgesia. (PubMed, Cureus) - "Urinary retention and pruritus were absent. Intrathecal nalbuphine with hyperbaric 0.5% bupivacaine is deemed safe with minimal side effects in endoscopic urology surgery."

Journal • Surgery • Anesthesia • Dermatology • Pain • Pruritus • Urology