ParenteralAcute painAdult: Lumbar block in labour pain: 0.25% soln: 15-30 mg (6-12 mL); 0.375% soln: 22.5-45 mg (6-12 mL); 0.5% soln: 30-60 mg (6-12 mL). Alternatively, 0.1% soln: 10-15 mg (10-15 mL) per hr; 0.125% soln: 10-15 mg (8-12 mL) per hr via infusion. Caudal block in labour pain: 0.25% soln: 25-50 mg (10-20 mL); 0.375% soln: 37.5-75 mg (10-20 mL); 0.5% soln: 50-100 mg (10-20 mL).
Child: 1-12 yr Caudal/Lumbar/Thoracic epidural block: 0.25% soln: 1.5-2 mg/kg. Field block/Peripheral nerve block: 0.25 or 0.5% soln: 0.5-2 mg/kg.
ParenteralPostoperative painAdult: 0.1% soln: 4-15 mg (4-15 mL) per hr; 0.125% soln: 5-15 mg (4-12 mL) per hr via epidural infusion. 1.3% liposomal susp: Bunionectomy: 106 mg (8 mL) as single dose (7 mL into surrounding tissues and 1 mL into SC tissue); haemorrhoidectomy: 266 mg (20 mL) as single dose, diluted to 30 mL preservative-free 0.9% NaCl for inj and infiltrated around the anal sphincter in 6 equally-divided portions.
ParenteralSurgical anaesthesiaAdult: Local infiltration: 0.25% soln: Up to 150 mg (60 mL). Peripheral nerve block: 0.25% soln: 12.5 mg (5 mL); 0.5% soln: 25 mg (5 mL); doses of up to 150 mg may also be given. Retrobulbar block in ophth surgery: 0.75% soln: 15-30 mg (2-4 mL). Sympathetic nerve block: 0.25% soln: 50-125 mg (20-50 mL). Lumbar epidural block: 0.25% soln: 25-50 mg (10-20 mL); 0.5% soln: 50-100 mg (10-20 mL); 0.75% soln in non-obstetric surgery: 75-150 mg (10-20 mL) as single dose. Caudal block: 0.25% soln: 37.5-75 mg (15-30 mL); 0.75% soln: 75-150 mg (15-30 mL). Spinal block: 0.5% soln: 10-20 mg (2-4 mL).
|
|
|
-
Bupispine Heavy
-
Bupivacaine Hydrochloride Antigen Pharm
-
Bupivacaine Pfizer
|
Patient w/ active CNS disease (e.g. meningitis, intracranial haemorrhage), TB of the spine, pyogenic infection on inj site, pre-anaesth elevated intracranial pressure. Not intended for IV regional anaesth (Bier's block) and paracervical block in obstetrics; obstetric epidural block (0.75% soln).
|
Patient w/ partial or complete heart block, impaired CV function and hypovolaemia; marked obesity, senility, cerebral atheroma, myocardial degeneration, toxaemia (epidural and spinal anaesth). May cause chondrolysis when given via intra-articular continuous infusion. Severe hepatic impairment. Pregnancy and lactation.
|
Bradycardia, hypotension, HTN, nausea, vomiting, diplopia, neuropathy, peripheral nerve injury, arachnoiditis, paresis and paraplegia, signs of CNS toxicity (e.g. convulsions, paraesthesia, tremor), dizziness, allergic reactions.
Potentially Fatal: Cardiac arrhythmia, cardiac and resp arrest.
|
Epidural/Intraspinal/IT/Parenteral/Perineural/SC: C
|
May temporarily impair locomotion and alertness.
|
Monitor CV and resp vital signs, state of consciousness, signs of CNS toxicity.
|
Symptoms: Convulsions, circulatory arrest, cardiac arrest, resp paralysis, hypotension, bradycardia. Management: Establish and maintain a patent airway, oxygen may be needed. If necessary, may give anticonvulsant drugs.
|
Additive systemic toxic effect w/ other local anaesth or agents structurally related to amide-type local anaesth (e.g. lidocaine and mexiletine). Increased risk of myocardial depression w/ antiarrhythmics. Enhanced adverse effects w/ hyaluronidase. Decreased clearance resulting to increased plasma concentrations w/ cimetidine and ranitidine. Increased risk of adverse effects w/ β-blockers and Ca channel blockers.
|
Description:
Mechanism of Action: Bupivacaine blocks both the initiation and conduction of nerve impulses reducing the permeability of neuronal membranes to Na ions resulting in inhibition of depolarization w/ resultant blockade of conduction.
Onset: 1-17 min (route and dose dependent).
Duration: 2-9 hr (route and dose dependent).
Pharmacokinetics:
Absorption: Time to peak plasma concentration: 30-45 min.
Distribution: Crosses the placenta, diffuses into CSF and enters breast milk (small amounts). Plasma protein-binding: Approx 95%.
Metabolism: Hepatic via conjugation w/ glucuronic acid; converted to pipecoloxylidine (major metabolite).
Excretion: Via urine mainly as metabolites; 5-6% as unchanged drug. Half-life: 1.5-5.5 hr
|
Soln for inj: Store between 20-25°C. Protect from light; Liposomal susp: Store between 2-8°C.
|
|
|
Anon. Bupivacaine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 25/07/2014. Buckingham R (ed). Bupivacaine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 25/07/2014. Exparel Injection, Suspension, Liposomal (Pacira Pharmaceuticals Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 25/07/2014. Wickersham RM. Bupivacaine HCl Injection. Facts and Comparisons [online]. St. Louis, MO. Wolters Kluwer Clinical Drug Information, Inc. https://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed 25/07/2014.
|
Sign Out
