Amides

The essential features of amides are:

• Amide drugs tend to be stable in solution and are not affected by autoclave sterilisation procedures
• Amide drugs cause fewer hypersensitivity reactions than esters
• Metabolism is mainly through the liver
• This group contains most of the commonly used local anaesthetics e.g. lidocaine, bupivacaine, ropivacaine and levobupivacaine.

Autoclave sterilisation procedures

Outside of the ED, some hospital sterilisation and disinfection unit (HSDU) packs include the anaesthetic, e.g. epidural packs may include the bupivacaine as an integral part of the pack. When these packs are autoclaved, the process leaves the anaesthetic unaltered, unless the autoclaving process is repeated multiple times.