Eladur (bupivacaine) / Durect, Amneal - LARVOL DELTA

Intrathecal bupivacaine monotherapy in patients with chronic refractory localized pain: a case series. (PubMed, Reg Anesth Pain Med) - "IDD with bupivacaine monotherapy may be effective in patients with localized pain. However, more studies are needed to establish the safety and efficacy of intrathecal bupivacaine monotherapy."

Journal • Monotherapy • Retrospective data • Back Pain • Musculoskeletal Pain • Pain

Bupivacaine serum concentrations during chronic intrathecal infusion for pain management: an observational single-center study. (PubMed, Reg Anesth Pain Med) - "Chronic intrathecal infusion of bupivacaine for cancer pain management results in systemic exposure well below the established toxicity threshold."

Journal • Observational data • Retrospective data • Anesthesia • Oncology • Pain

Local Anesthetic Systemic Toxicity Following Delivery of Intrathecal Bupivacaine in an Infant. (PubMed, Paediatr Anaesth) - No abstract available

Journal • Anesthesia

Anesthetic Challenges in Dystrophic Epidermolysis Bullosa: A Regional Approach for Below-Knee Amputation (ASA 2026) - "To avoid airway manipulation, a neuraxial technique with intrathecal bupivacaine and fentanyl was performed. Sedation was provided with midazolam and remifentanil, and analgesia was supplemented with a femoral nerve block. Strict precautions minimized skin trauma during monitoring. The procedure and postoperative course were uneventful."

Mood Disorders • Squamous Cell Carcinoma

Anesthetic Management of Cesarean Delivery in a Parturient With Severe Pulmonary Arterial Hypertension (ASA 2026) - "Sequential combined spinal-epidural anesthesia with low-dose intrathecal bupivacaine achieved gradual sympathectomy. Prophylactic norepinephrine and vasopressin infusions with 500 mL 5% albumin bolus were initiated pre-neuraxial; epinephrine infusion was added post-blockade for inotropic support. Invasive monitoring and multidisciplinary coordination facilitated successful delivery of the baby and safe intraoperative management of this high-risk parturient."

Cardiovascular • Immunology • Inflammatory Arthritis • Lupus • Pulmonary Arterial Hypertension • Pulmonary Embolism • Respiratory Diseases • Systemic Lupus Erythematosus

Comparative Efficacy and Safety of Intrathecal Bupivacaine, Levobupivacaine, and Ropivacaine for Cesarean Spinal Anesthesia: A Systematic Review and Network Meta-analysis (ASA 2026) - "Abstract is embargoed at this time."

Retrospective data • Review • Anesthesia

Comparison of continuous epidural analgesia, traditional combined spinal-epidural, and modified combined spinal-epidural for labor analgesia: a multicenter retrospective cohort study. (PubMed, Front Med (Lausanne)) - "All intrathecal bupivacaine doses were hyperbaric. Other maternal and neonatal outcomes should be interpreted cautiously due to limited power for rare events. Overall, the results support modified CSE as a pragmatic refinement of neuraxial labor analgesia in routine clinical practice."

Journal • Retrospective data • Hypotension • Pain

Inadequate spinal anesthesia for postpartum tubal ligation: a single-center retrospective analysis (2003-2025). (PubMed, Int J Obstet Anesth) - "Intrathecal hyperbaric bupivacaine at a dose ≥13.5 mg was associated with lower odds of inadequate anesthesia for postpartum tubal ligation compared with 10.5-12 mg in the context of an evolving institutional practice."

Journal • Retrospective data • Anesthesia • Pain

Prevalence, factors associated, and adverse maternal outcomes of spinal induced hypotension among mothers undergoing caesarean section at a tertiary hospital South-Western Uganda. (PubMed, BMC Anesthesiol) - "The prevalence of spinal-induced hypotension among mothers undergoing caesarean section at MRRH is high. We recommend routine administration of prophylactic vasopressor during all caesarean sections and clinicians to recognize these factors associated with spinal induced hypotension."

Adverse events • Journal • Anesthesia • Cardiovascular • Hypotension • Obstetrics

Comparing additive effect of dexmedetomidine and neostigmine to bupivacaine on postspinal anesthesia cesarean section induced pain intensity: A health promotion Approach. (PubMed, J Educ Health Promot) - "Using dexmedetomidine exerts a greater and better effect on reducing pain intensity and boosts the sedative effect of neostigmine in the patients undergoing CS. It is suggested to run a study with a larger statistical community to deal with this issue. The results of this study can be useful in making prevention decisions and maintaining performance of women."

Journal • Anesthesia • Pain

Anesthetic recovery profiles of intrathecal ropivacaine and bupivacaine in ASA I-II patients undergoing outpatient total hip arthroplasty. (PubMed, BMC Anesthesiol) - "Intrathecal ropivacaine provides a shorter motor block duration and faster early recovery compared with bupivacaine in outpatient THA, without increasing postoperative complications, but confirmation in a well-designed prospective study is warranted."

Journal • Anesthesia • Orthopedics

Intrathecal bupivacaine versus bupivacaine plus fentanyl for anaesthesia for Caesarean delivery: noninferiority analysis and exclusions. Response to Br J Anaesth 2026, doi: 10.1016/j.bja.2026.02.052. (PubMed, Br J Anaesth) - No abstract available

Head-to-Head • Journal • Anesthesia

Parturients Vulnerability to Hyperbaric Bupivacaine-Induced Neurotoxicity After Intrathecal Administration: A Series of Four Cases. (PubMed, Cureus) - "While generally safe, neurotoxicity following intrathecal bupivacaine is rare...The clustering of cases linked to a single suspected faulty batch further underscores the need for stringent pharmacovigilance and drug quality assurance. Early recognition, airway management, and supportive therapy are crucial for desired outcomes. Enhanced vigilance, dose optimization, and robust quality control of anaesthetic agents are essential to improve obstetric anaesthesia safety."

Journal • Anesthesia • CNS Disorders • Epilepsy • Obstetrics • Pain

Single-Shot Intrathecal Bupivacaine With Fentanyl vs. Dexmedetomidine for Labor Analgesia: A Randomized Controlled Trial. (PubMed, Anesthesiol Res Pract) - P4 | "Dexmedetomidine added to intrathecal bupivacaine produced good labor analgesia with high maternal satisfaction, with low side effects, and could be used as a better substitute for fentanyl. Trial Registration: ClinicalTrials.gov: NCT06823349."

Clinical • Journal • Anesthesia • Cardiovascular • Pain

Intrathecal bupivacaine versus bupivacaine plus fentanyl as anaesthesia for Caesarean delivery: noninferiority analysis and exclusions. Comment on Br J Anaesth 2026; 136: 584-90. (PubMed, Br J Anaesth) - No abstract available

Head-to-Head • Journal • Anesthesia

Fractionated vs single-shot intrathecal bupivacaine for cesarean delivery: A systematic review and meta-analysis (ASRA-SPRING 2026) - "Fractionation also prolonged sensory, motor, and analgesic block duration without affecting onset.These effects likely result from a more gradual sympathetic blockade rather than a reduction in anesthetic dose. Despite protocol heterogeneity and limited reporting of secondary outcomes, fractionated spinal anesthesia appears to be a simple, reproducible strategy to improve hemodynamic stability during cesarean delivery."

Retrospective data • Review • Hypotension

Hemodynamic effects of plain versus hyperbaric bupivacaine during spinal anesthesia for total knee arthroplasty: a randomized clinical trial. (PubMed, Reg Anesth Pain Med) - P4 | "In this superiority trial using 10 mg intrathecal bupivacaine for elective TKA, superiority of PB over HB for early hemodynamic stability was not demonstrated."

Clinical • Journal • Anesthesia • Hypotension • Orthopedics • Pain

Spinal anaesthesia for caesarean delivery in India: a national cross-sectional survey of anaesthesiologists' practice (2025). (PubMed, Int J Obstet Anesth) - "This national survey demonstrated considerable heterogeneity in spinal anaesthesia practices for caesarean delivery among Indian anaesthesiologists, influenced by their clinician experience. Although several practices were consistent with international guidelines, important deviations persisted, particularly regarding the use of wedge for left uterine displacement, spinal needle selection, choice of vasopressor for spinal-induced hypotension, and intrathecal adjuvants. These findings underscore the need for wider dissemination of guidelines and improved standardisation to optimise obstetric anaesthesia practice and outcomes."

Journal • Anesthesia • Hypotension • Obstetrics • Pain

Comparative Study of Fixed Dose versus Height-adjusted Dose of Heavy Bupivacaine in Spinal Anesthesia for Elective Cesarean Section. (PubMed, Ann Afr Med) - "Height-adjusted intrathecal bupivacaine ensures reliable surgical anesthesia with improved maternal hemodynamic stability and fewer side effects, without compromising neonatal outcomes."

Journal • Anesthesia • Cardiovascular • Critical care • Hypotension • Metabolic Disorders

Impact of Adjuvants on Post-Spinal Urinary Retention: A Comparative Study of Dexmedetomidine and Fentanyl in Knee Arthroscopy. (PubMed, Clin Ter) - "Patients were randomly assigned to receive intrathecal bupivacaine with either dexmedetomidine (Group D) or fentanyl (Group F). Intrathecal dexmedetomidine is superior to fentanyl in reducing POUR and enhancing postoperative analgesia for knee arthroscopy. Its use may optimize recovery protocols, particularly in ambulatory orthopedic surgeries."

Clinical • Journal • Anesthesia • Orthopedics • Pain

Autoregressive With Exogenous Input (ARX) Decision Support for Blood Pressure Maintenance During Cesarean Delivery Under Spinal Anesthesia: A Prospective Pilot Study With Matched Nonconcurrent Controls. (PubMed, medRxiv) - "ARX-guided patients were matched 1:2 to nonconcurrent controls (n = 40) on attending anesthesiologist and intrathecal bupivacaine dose, with nearest-neighbor matching on age and body mass index...Question: In pregnant patients at term undergoing elective cesarean delivery under spinal anesthesia, can a real-time ARX algorithm accurately forecast MAP and support vasopressor management? Findings: One-minute-ahead forecasts were accurate (RMSE 3.71 mmHg), and ARX-guided care was associated with a shorter duration of hypotension and a higher phenylephrine dose versus matched nonconcurrent controls Meaning: Real-time MAP forecasting is feasible and warrants randomized evaluation to confirm clinical benefit and characterize trade-offs."

Journal • Anesthesia • Hypotension

A Randomized Controlled Trial of Intrathecal 1% Chloroprocaine Versus 0.75% Hyperbaric Bupivacaine for Short Obstetric Procedures. (PubMed, Cureus) - "Background Intrathecal bupivacaine is commonly used for short obstetric procedures, including transvaginal cerclage placement, external cephalic version, and postpartum bilateral tubal ligation, despite evidence that chloroprocaine is associated with earlier postanesthesia care unit discharge after ambulatory surgery...Conclusion When utilized for transvaginal cerclage placement and external cephalic version, intrathecal chloroprocaine may shorten motor block, time to postanesthesia care unit discharge readiness, time to first ambulation, and reduce the frequency of bladder catheterization. Administration of 50 mg of 1% chloroprocaine intrathecally does not provide adequate anesthesia for bilateral tubal ligation surgery."

Journal • Anesthesia • Obstetrics

Successful Vaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) Hysterectomy Under Spinal Anesthesia for an Obese Patient. (PubMed, Cureus) - "The patient received intrathecal bupivacaine with morphine, followed by sedation with midazolam. Postoperatively, she experienced minimal pain controlled with oral analgesics, no nausea or vomiting, and was ambulatory within hours. To our knowledge, this is the first reported case of V-NOTES hysterectomy done under spinal anesthesia in an obese patient, highlighting its feasibility, safety, and potential for broader clinical use."

Journal • Anesthesia • Genetic Disorders • Gynecology • Obesity • Pain

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