Bupivacaine

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Bupivacaine is an amide-type local anaesthetic. It has a slow onset but long duration of action. It binds to plasma proteins and has a plasma half-life of 1.5-5.5 hours. It is largely metabolised in the liver. The maximum dose is 2.5mg/kg.

It is the most cardiotoxic of all the local anaesthetics. The cardiotoxic effect is enhanced by hypoxia, hypercapnia, acidosis, and hyperkalaemia. Ventricular fibrillation is a risk due to inhibition of cardiac conductivity and contractility. It should be avoided in patients with cardiac disease.