Which local anesthetic is preferred for prolonged procedures?

Bupivacaine is the preferred local anesthetic for prolonged procedures due to its longer duration of action. This characteristic is particularly valuable in lengthy surgical or dental interventions, as it provides extended pain relief for the patient, allowing the procedure to be performed without frequent re-administration of the anesthetic. Bupivacaine's pharmacokinetic properties, including its slower metabolism and lower systemic clearance, contribute to its sustained effect, making it ideal for situations where pain management needs to last for several hours.

In contrast, other local anesthetics, such as lidocaine, while having a rapid onset of action, do not provide the same length of analgesia, requiring more frequent dosing. Mepivacaine is associated with minimal vasodilation but does not outperform bupivacaine in terms of duration. Articaine is known for its fast absorption but lacks the extended duration that bupivacaine offers, making it less suitable for prolonged procedures. Thus, bupivacaine stands out as the optimal choice when extended duration of anesthesia is necessary.