Bupivacaine-Induced Myonecrosis

Abstract

There are several common adverse events of local anesthetics, such as seizure and cardiac toxicity. A less common side effect, such as localized soft tissue response to local anesthetic, may remain underdiagnosed and underappreciated in clinical practice. All local anesthetics produce some degree of myotoxicity, bupivacaine the worst, and procaine the least. Myotoxicity results from the disruption of mitochondria abundantly present in muscle cells. If local anesthetics are combined with glucocorticoids, muscle breakdown increases. The mechanism of myotoxicity, thought to be affected by the concentration of local anesthetic, is time dependent, enhanced by preexisting altered metabolism, and is often associated with young age. There are several possible strategies that may reduce or even prevent local anesthetic-induced myotoxicity. Care should be taken to evaluate the potential effects of long-term or repeated administration of local anesthetics to prevent this complication.