Addition of bicarbonate to plain bupivacaine does not significantly alter the onset or duration of plexus anesthesia.

Abstract

In an effort to elucidate further the effect of alkalinization of bupivacaine on its anesthetic effect, a study was undertaken using alkalinized and non-alkalinized bupivacaine for lumbar plexus block and comparing the results with those obtained previously with brachial plexus block. Thirty consenting adult patients about to undergo lower extremity surgery under regional anesthesia were selected for the study. All of the patients received an inguinal paravascular lumbar plexus block ("3-in-1 block"), along with a sciatic block to allow the anticipated surgery to be carried out. The patients were divided into two groups, one receiving plain "alkalinized" 0.5% bupivacaine; the other receiving plain "non-alkalinized" 0.5% bupivacaine. After each lumbar plexus block, the onset and duration of analgesia and anesthesia of the nerves derived from the lumbar plexus were determined by an independent investigator who was unaware of which solution had been administered. There was no statistically significant difference between the two groups with respect to the onset or duration of anesthesia and analgesia. The data obtained in the present study indicate that alkalinization of non-epinephrine-containing bupivacaine does not reduce the latency or increase the duration of analgesia or anesthesia after lumbar plexus block. Since most of the studies that do show such an effect of alkalinization were carried out using epinephrine-containing bupivacaine, it is postulated that in those studies alkalinization contributed to the decrease in latency and increase in duration, not so much by providing an increased amount of local anesthetic in the free base form, but by reactivating epinephrine's vasoconstrictor activity, which is inactivated by a low pH.