BUPIVACAINE HYDROCHLORIDE
| BUPIVACAINE HYDROCHLORIDE (byoo-piv'a-kane) Marcaine, Sensorcaine Classifications: local anesthetic (amide-type); Therapeutic:anesthetic, local Prototype: Procaine Pregnancy Category: C |
Availability
0.25%, 0.5%, 0.75% injection
Action
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.
Therapeutic Effect
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.
Uses
Infiltration anesthesia; peripheral, sympathetic nerve, and epidural (including caudal) block anesthesia; 0.75% bupivacaine solution in dextrose is used for spinal anesthesia.
Contraindications
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).
Cautious Use
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
| Infiltration Anesthesia 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 1–3.7 mg/kg |
Administration
Intramuscular- 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]. CNS: 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. Urogenital: 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 injection).Interactions
Drug: cns depressants augment CNS depression; with isoproterenol, ergonovine there is persistent hypertension and a risk of CVA if bupivacaine used with epinephrine. mao inhibitors, tricyclic antidepressants, phenothiazines cause severe or prolonged hypotension or hypertension if bupivacaine used with epinephrine.Pharmacokinetics
Onset: 4–17 min (epidural, caudal, peripheral, or sympathetic block); within 1 min (spinal block). Duration: 3–5 h (epidural, caudal, peripheral, or sympathetic block); 1.25–2.5 h (spinal block). Distribution: Crosses placenta. Metabolism: In liver. Elimination: 6% unchanged in urine. Half-Life: 1.5–5.5 h in adults, 8.1 h in neonates.Nursing Implications
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 2.5–3.5 h.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug