Bupivacaine

Details About Generic Salt ::  Bupivacaine 

Main Medicine Class:: Anesthetics   Sub Medicine Class ::  Local Anesthetics

16B. LOCAL ANESTHETICS in 16. ANESTHETICS
BUPIVACAINE
AMIDE TYPE ANESTHETIC | LOCAL ANESTHETIC
PK: A: Readily absorbed (mucous membranes) M: Hepatic E: Urine (~6% unchanged)

Indications & Dose: CAUDAL BLOCK Adult 15-30mL of 0.25% or 0.5% (preservative free) Child >12 yr: Same as adult dose | EPIDURAL BLOCK Adult 10-20mL of 0.25% or 0.5% given in 3-5mL increments, allowing sufficient time to detect toxic manifestations of inadvertent IV/IT Child >12 yr: Same as adult dose | INFILTRATION ANESTHESIA Adult 0.25% infiltrated locally max 175mg. For prolonged anesthesia (dental/maxillary & mandibular area) 0.5% solution with adrenaline (1 in 2, 00, 000) has been used, 90mg (18mL) should not be exceeded over a single dental sitting Child >12 yr: Same as adult dose | LABOR PAIN Adult Bolus caudal injection: 25-50mg (10-20mL) as 0.25% solution or 50-100mg (10-20mL) as 0.5% solution | PERIPHERAL NERVE BLOCK Adult 5mL of 0.25% or 0.5%, max 400 mg/day Child >12 yr: Same as adult dose | POST-OPERATIVE PAIN Adult Epidural inf : 4-15mg (4-15mL) q1h as 0.1% solution or 5-15mg (4-12mL) q1h as 0.125% solution | RETROBULBAR ANESTHESIA Adult 2-4mL of 0.75% Child >12 yr: Same as adult dose | SPINAL ANESTHESIA Adult Preservative free solution of 0.75% bupivacaine in 8.25% dextrose: 1mL for lower extremity & perineal procedures, 1.6mL for lower abdominal procedures, 0.8mL for normal vaginal delivery, 1-1.4mL for cesarean section | SYMPATHETIC NERVE BLOCK Adult 20-50mL of 0.25% Child >12 yr: Same as adult dose

Contra: Hypersensitivity, obstetrical paracervical block anesthesia, adjacent skin infect/inflamed skin, concomitant anticoagulant therapy, severe anemia/CVD, spinal/epidural anesthesia in dehydrated/hypovolemic patients, IV regional anesthesia (Bier’s block) & for paracervical block in obstetrics

Precautions: Mild-to-moderate CVD, acutely ill patients, debilitated patients, elderly, respiratory impairment, hepatic impairment, epilepsy, porphyria, myasthenia gravis, children, impaired cardiac conduction/shock, should not be instilled into the middle ear

ADR: Serious: Hypotension, bradycardia, palpitation, heart block, ventricular arrhythmia, cardiac arrest, seizure, paralysis, urinary incontinence, chondrolysis, tinnitus, apnea, allergic reactions, anaphylactoid reactions, Others: hypoventilation, weakness, blurred vision, anxiety, dizziness

DDI: Serious Verapamil/Captopril cause severe hypotension & bradycardia, Propofol dose need to reduce, Ropivacaine epidural (postoperatively) may cause motor block, Diazepam increases drug level, Midazolam increases sedative effect of drug, Risperidone leads to exaggerated hypotension by drug (spinal anaesthesia), Propranolol/Itraconazole reduces drug clearance

Monitor: Vital signs, state of consciousness, signs of CNS toxicity