Extradural lumbar block with bupivacaine (Marcain: LAC‐43)

The synthesis of bupivacaine, a homologue of mepivacaine and therefore chemically related to lignocaine was reported by af Ekenstam et al in 1957 2. Pharmacological studies by Henn & Brattsand 3 indicated that bupivacaine was about four times as toxic and three times as potent as mepivacaine, and had a substantially longer duration of action. The prolonged effect in extradural block was confirmed clinically by Herbring4 and by Ekblom & Widmans. Bupivacaine was found to be similar in speed of onset, effectiveness and incidence of complications to mepivacaine and prilocaine, but to have almost twice the duration of action of these agents. Analogous findings were reported by Telivuo 6 who used bupivacaine for intercostal nerve block after chest surgery.