Classifications: local anesthetic (amide-type); Therapeutic:anesthetic, local
Pregnancy Category: C
0.25%, 0.5%, 0.75% injection
Anesthetic of the amide type that decreases sodium flux into nerve cell, inhibiting initial depolarization, and prevents
propagation and conduction of the nerve impulse. Progression of anesthesia, related to diameter, myelination, and conduction
velocity of affected fibers is manifested clinically as sequential loss of nerve function.
Primary depressant effect is in medulla and higher centers affecting patient's reaction to pain, temperature, and touch,
as well as proprioception and skeletal muscle tone.
Infiltration anesthesia; peripheral, sympathetic nerve, and epidural (including caudal) block anesthesia; 0.75% bupivacaine
solution in dextrose is used for spinal anesthesia.
Known sensitivity to bupivacaine, local anesthetics, other amide-type anesthetics. Parabens, or metabisulfites; acidosis;
heart block; severe hemorrhage, uncontrolled coagulopathy; hypotension and shock; hypertension, cerebrospinal diseases; obstetrical
paracervical anesthesia or spinal anesthesia in septicemia; topical or IV regional anesthesia; intercurrent use with chloroprocaine;
history of malignant hyperthermia; pregnancy (category C).
Older adults or debilitated patients, dehydration; hepatic or renal disease, neurologic diseases; known drug allergies and
sensitivities; dysrhythmias; lactation, children >16 y; obstetrical delivery.
Route & Dosage
Adult: IM Local infiltration, sympathetic block 0.25% solution; Lumbar epidural 0.25%, 0.5%, 0.75% solutions; Caudal block, peripheral nerve block 0.25%, 0.5% solutions; Retrobulbar block 0.75% solution
Child: IM 13.7 mg/kg
- Inject slowly with frequent aspirations to avoid intravascular injection.
- Do not use preparations containing preservatives for epidural or spinal anesthesia.
- Do not use multiple-dose vial for lumbar or caudal epidural block.
- Store ampules at 15°30° C (59°86° F); protect from freezing. Solutions with epinephrine should
be protected from light.
INCOMPATIBILITIES Solution/additive: Sodium bicarbonate.
Adverse Effects (≥1%) Body as a Whole:
Hypersensitivity [cutaneous lesions, urticaria, sneezing, diaphoresis, syncope, hyperthermia, angioneurotic edema (including laryngeal edema), anaphylaxis, anaphylactoid reaction
Nervousness, unusual anxiety, excitement, dizziness, drowsiness, tremors, convulsions, unconsciousness, respiratory arrest. Special Senses:
Pupillary constriction; blurred or double vision; tinnitus. GI:
Nausea, vomiting. Other:
Inflammation or sepsis at injection site, chills, pupillary constriction. Associated with Epidural Anesthesia, Body as a Whole:
Total spinal block, persistent analgesia, paresthesia
Urinary retention, fecal incontinence, loss of perineal sensation and sexual function. Other:
Slowing of labor, increased incidence
of forceps delivery, cranial nerve palsies (with inadvertent intrathecal
Interactions Drug: cns depressants
depression; with isoproterenol, ergonovine
there is persistent hypertension and a risk of CVA if bupivacaine used with epinephrine. mao inhibitors
, tricyclic antidepressants
cause severe or prolonged hypotension or hypertension if bupivacaine used with epinephrine.
417 min (epidural, caudal, peripheral, or sympathetic block); within 1 min (spinal block). Duration:
35 h (epidural, caudal, peripheral, or sympathetic block); 1.252.5 h (spinal block). Distribution:
Crosses placenta. Metabolism:
In liver. Elimination:
6% unchanged in urine. Half-Life:
1.55.5 h in adults, 8.1 h in neonates.
Assessment & Drug Effects
- Monitor for signs of inadvertent intravascular injection, which can produce a transient "epinephrine response" (increased
heart rate or systolic BP or both, circumoral pallor, palpitations, nervousness) within 45 seconds in the unsedated patient
and an increase by 20 bpm or more in heart rate for at least 15 seconds in sedated patient.
- Vasoconstrictor-containing solution should be administered cautiously, if at all, to areas with end arteries (e.g., digits,
penis) or to areas that have a compromised blood supply; ischemia and gangrene can result. Inspect areas for evidence of
reduced perfusion because of vasospasm: pale, cold, sensitive skin.
- Note: Systemic reactions (toxicity) are more apt to occur in children or older adults and may develop rapidly or be delayed for
as long as 30 min after administration.
- Monitor for toxicity: CNS stimulation (unusual anxiety, excitement, restlessness) usually occurs first, followed by CNS
depression (drowsiness, unconsciousness, respiratory arrest). However, because stimulation is apt to be transient or absent,
drowsiness may be the first sign in some patients (especially children and older adults).
- Monitor BP and fetal heart rate continuously during labor because maternal hypotension may accompany regional anesthesia.
Place mother on left side with legs elevated.
- Monitor cardiac and respiratory status continuously in patients receiving retrobulbar and dental blocks.
Patient & Family Education
- After spinal anesthesia, sensation to lower extremities may not return for 2.53.5 h.