Bupivacaine, propofol could be easily confused, safety group warns

A medication safety coalition last week warned that local anesthetic bupivacaine (Exparel) looks similar to propofol, and its accidental use could cause serious adverse events and death.

Bupivacaine (Exparel) and propofol are both white emulsions used in similar settings and are packaged in vials that look similar. “When prepared in syringes these products essentially look identical,” according to the alert by the National Alert Network, a coalition of members of the National Coordinating Council on Medication Error Reporting and Prevention.

If bupivacaine is accidentally administered intravenously instead of propofol, it may result in toxic blood concentrations and depressed cardiac conductivity and excitability. These may lead to atrioventricular block, ventricular arrhythmias, and cardiac arrest, the alert said. To date, there have been no reports of mix-ups of these two medications, it said.

To prevent the possibility of errors, the two products should be stored in separate areas and staff members should be reminded not to leave any medication or syringe unlabeled, it said. Directions for treatment of bupivacaine toxicity should be available in all surgical areas where bupivacaine is used; a checklist for treatment is available online.