Bacsik C J, Swift J Q, Hargreaves K M
University of Minnesota School of Dentistry, Minneapolis, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Jan;79(1):18-23. doi: 10.1016/s1079-2104(05)80067-8.
Since the introduction of the long-acting agents, bupivacaine in 1983 and etidocaine in 1985, to the dental local anesthetic armamentarium, their use has increased rapidly. Although an estimated one-half million local anesthetic injections are administered in the United States daily, the actual risks of toxicity from these local anesthetic injections remain unknown. Our review of the literature reveals numerous cases of severe adverse reactions associated with the administration of bupivacaine and etidocaine. This case review includes several fatalities, even after injection of only very small amounts of these long-acting local anesthetics. Results from animal studies have demonstrated increased systemic toxicity associated with bupivacaine and etidocaine as compared with lidocaine, the most extreme of which include severe central nervous system and cardiovascular reactions, eventually leading to hemodynamic instability, cardiovascular collapse, and death. Although many aspects of the side effect profile of bupivacaine and etidocaine are common to all local anesthetics, the physiochemical properties of the long-acting local anesthetics enhance their adverse effects. It is therefore imperative that the dental practitioner who uses these long-acting local anesthetics become familiar with the adverse reactions of these drugs.
自1983年长效局麻药布比卡因和1985年依替卡因被引入牙科局部麻醉药库以来，它们的使用迅速增加。尽管在美国每天估计进行50万次局部麻醉注射，但这些局部麻醉注射导致中毒的实际风险仍然未知。我们对文献的回顾发现了许多与布比卡因和依替卡因给药相关的严重不良反应病例。本病例回顾包括几例死亡病例，即使仅注射了极少量的这些长效局部麻醉药。动物研究结果表明，与利多卡因相比，布比卡因和依替卡因的全身毒性增加，其中最严重的包括严重的中枢神经系统和心血管反应，最终导致血流动力学不稳定、心血管衰竭和死亡。尽管布比卡因和依替卡因副作用的许多方面是所有局部麻醉药共有的，但长效局部麻醉药的理化性质会增强其不良反应。因此，使用这些长效局部麻醉药的牙科医生必须熟悉这些药物的不良反应。
