The Bupivacaine Story: A Tribute to George A. Albright, MD (1931-2020)

Abstract

(Anesth Analg. 2022;135:1115–1119) In 1978, George A. Albright, MD (1931-2020) presented an editorial for publication titled, “Cardiac Arrest Following Regional Anesthesia with Etidocaine or Bupivacaine.” Starting in 1963, bupivacaine became a promising local anesthetic used around the world. At a time when bupivacaine during obstetric anesthesia was a standard practice, George Albright’s manuscript reported 5 cases showed that bupivacaine was associated with an increased mortality rate compared with other local anesthetics during epidurals or brachial plexus blocks. Raising the question of bupivacaine cardiotoxicity and calling for further investigation of bupivacaine use sparked controversy. C. Philip Larson, MDCM, MS, Professor and Chair of the Department of Anesthesia at Stanford and Editor-in-Chief of Anesthesiology at the time of Dr. Albright’s editorial submission, decided to publish the piece despite it receiving harsh criticism from expert reviewers. Dr Albright’s controversial editorial ultimately led to several important anesthesiology advancements, including laboratory studies proving bupivacaine cardiotoxicity, the discontinuation of bupivacaine 0.75% epidurally in clinic, safeguards before incremental anesthetic injection, development of less toxic local anesthetics, and further research into intravenous lipid emulsion to counteract adverse effects of bupivacaine cardiotoxicity. Stemming from Dr. Albright’s research, from 1983 to 1999, the US Food and Drug Administration (FDA) issued a black box warning against 0.75% bupivacaine use during obstetric anesthesia.