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Bupivacaine information from DrugsUpdate  

See Available Brands of Bupivacaine in India

P - Contraindicated in pregnancy
L - Contraindicated in lactation

Bupivacaine (rINN)is a local anaesthetic drug belonging to the amino amide group. AstraZeneca commonly markets it under various trade names, including Marcain, Marcaine, Sensorcaine and Vivacaine.

Pharmacodynamics

Pharmacokinetics

Bupivacaine blocks both the initiation and conduction of nerve impulses reducing the permeability of neuronal membranes to Na ions resulting in inhibition of depolarization with resultant blockade of conduction.
Onset: 4-10 min.
Duration: 1.5-8.5 hr.
Distribution: Crosses the placenta, diffuses into CSF, enters breast milk (small amounts). Protein-binding: 95%.
Metabolism: Hepatic.
Excretion: Urine (as metabolites); 1.5-5.5 hr (elimination half-life).

Bupivacaine Indications / Bupivacaine Uses

In percutaneous infiltration anaesthesia.

Bupivacaine Adverse Reactions / Bupivacaine Side Effects

CNS excitation may be followed by depression. Hypotension, bradycardia, arrhythmias and cardiac arrest; methaemoglobinaemia; seizures, restlessness, dizziness. Hypersensitivity. Prolonged block.
Potentially Fatal: Cardiac and sudden respiratory arrest.

Precautions

Overdosage: Management includes careful and constant monitoring of CV and respiratory vital signs and the patient’s state of consciousness after each local anaesthetic inj. Establish and maintain a patent airway, oxygen may be needed. If necessary, drugs may be used to control convulsions. Hypotension may also be managed by giving IV fluids such as sodium chloride injection.

Special Precautions

Hepatic disease; CV disease; children <12 yr; pregnancy. Elderly and debilitated patients.

Other Drug Interactions

Decreased duration with hyaluronidase. Decreased clearance with cimetidine and ranitidine. Potentiates lidocaine and mepivacaine. Allergic-type reactions with formulations containing sodium metabisulfite.
Potentially Fatal: May potentiate systemic toxicity of other local amide anaesthetics. Increased risk of myocardial depression with antiarrhythmics.

Dosage

Injection
Percutaneous infiltration anaesthesia
Adult: 0.25% solution is typically used. For prolonged action: 9 mg (1.8 ml) of a 0.5% solution with adrenaline (1:200,000) can be admin, repeated once after 2-10 min if necessary. Max total: 90 mg/dental sitting. Max single dose: 150 mg with or without adrenaline, followed by 50 mg every 2 hr if needed.
Injection
Peripheral nerve block
Adult: 12.5 mg (5 ml) of a 0.25% solution or 25 mg (5 ml) of a 0.5% solution. Max single dose: 150 mg with or without adrenaline, followed by 50 mg every 2 hr if needed.
Injection
Sympathetic nerve block
Adult: 50-125 mg (20-50 ml) of a 0.25% solution.
Injection
Retrobulbar block
Adult: 15-30 mg (2-4 ml) of a 0.75% solution.
Injection
Caudal block
Adult: In surgery: 37.5-75 mg (15-30 ml) of a 0.25% solution or 75-150 mg (15-30 ml) of a 0.5% solution. With analgesia during labour: 25-50 mg (10-20 ml) of a 0.25% solution or 50-100 mg (10-20 ml) of a 0.5% solution.
Injection
Lumbar epidural block
Adult: In surgery: 25-50 mg (10-20 ml) of a 0.25% solution or 50-100 mg (10-20 ml) of a 0.5% solution. With analgesia during labour: 15-30 mg (6-12 ml) of a 0.25% solution or 30-60 mg (6-12 ml) of a 0.5% solution. In non-obstetric surgery: 75-150 mg (10-20 ml) of a 0.75% solution.

Food(before/after)

Information Not Available

List of Contraindications

Bupivacaine and Pregnancy

Caution when used during pregnancy.
Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Bupivacaine and Lactation

Contraindicated in lactation

Bupivacaine and Children

Information Not Available

Bupivacaine and Geriatic

Hypersensitivity to local anaesthetics of amide type. IV regional anaesthesia; paracervical block in obstetrics; spinal anaesthesia <18 yr. Lactation. Solutions containing preservatives for caudal or epidural block.

Bupivacaine and Other Contraindications

Information Not Available

Storage

nformation Not Available

Lab interference

nformation Not Available

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