Classes
DEA Class; Rx
Common Brand Names; Marcaine, Marcaine Spinal, POSIMIR, Sensorcaine, Sensorcaine MPF, Xaracoll
Amide Local Anesthetics
Description
Amide local anesthetic
Used for local or regional anesthesia or analgesia for surgery, dental and oral surgery procedures, diagnostic and therapeutic procedures, and obstetrical procedures
Not all blocks indicated for use with bupivacaine given clinically significant risks associated with use
Indications
Contraindications
Avoid inadvertent intravenous administration, intraarterial administration, or intrathecal administration of bupivacaine. Bupivacaine is contraindicated for use as intravenous regional anesthesia (Bier Block) due to reports of cardiac arrest and death.
Bupivacaine use requires an experienced clinician who is well versed in the diagnosis and management of dose-related toxicity and other acute emergencies that might arise from bupivacaine exposure.
Adverse Effects
pulmonary hypertension
seizures
apnea
respiratory arrest
muscle paralysis
ventricular tachycardia
bradycardia
cardiac arrest
arrhythmia exacerbation
AV block
ventricular fibrillation
laryngeal edema
anaphylactoid reactions
angioedema
cranial nerve palsies
coma
fetal death
chondrolysis
malignant hyperthermia
methemoglobinemia /
Warnings
–
Pregnancy and Lactation
Bupivacaine is contraindicated in patients undergoing obstetrical paracervical nerve block anesthesia
Maximum Dosage
The bupivacaine dose varies with the procedure, area to be anesthetized, tissue vascularity, number of neuronal segments to be blocked, required depth of anesthesia and degree of muscle relaxation, desired duration of anesthesia, as well as patient tolerance and physical condition.
175 mg/dose and 400 mg/24 hours for all parenteral routes; 300 mg/procedure for implant; 660 mg/procedure for subacromial space infiltration.
175 mg/dose and 400 mg/24 hours for all parenteral routes; 300 mg/procedure for implant; 660 mg/procedure for subacromial space infiltration.
175 mg/dose and 400 mg/24 hours for all parenteral routes. Safety and efficacy have not been established for implant or subacromial space infiltration.
12 years: 175 mg/dose and 400 mg/24 hours for all parenteral routes. Safety and efficacy have not been established for implant or subacromial space infiltration.
1 to 11 years: 2.5 mg/kg/dose (Max: 175 mg/dose) and 400 mg/24 hours for all parenteral routes. Safety and efficacy have not been established for implant or subacromial space infiltration.
6 to 11 months: 2.5 mg/kg/dose for all parenteral routes. Safety and efficacy have not been established for implant or subacromial space infiltration.
1 to 5 months: 1.75 mg/kg/dose for all parenteral routes. Safety and efficacy have not been established for implant or subacromial space infiltration.
Safety and efficacy have not been established.
How supplied
Articaine/epinephrine
Intrathecal Inj Sol: 0.75-8.25%
Intracaudal Inj Sol: 0.25%, 0.5%
Intramuscular Inj Sol: 0.25%, 0.5%
Perineural Inj Sol: 0.25%, 0.5%
Marcaine Epidural Sol: 0.25%
Marcaine Infiltration Sol: 0.25%
Marcaine Intraspinal Inj Sol: 0.75-8.25%
Sensorcaine MPF Subarachnoid Inj Sol: 0.75-8.25%
Xaracoll Subcutaneous Imp: 100mg