Classes
DEA Class; Rx
Common Brand Names; Marcaine, Sensorcaine, Posimir, Exparel, XaraColl
- Local Anesthetics, Amides;
- Local Anesthetics, Dental;
- Local Anesthetics, Parenteral
- Amides
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
Marcaine spinal, Sensorcaine-MPF Spinal, generic
Indicated for the production of subarachnoid block (spinal anesthesia)
Contraindications
Hypersensitivity to any amide local anesthetics, or other product components
Marcaine
Undergoing obstetrical paracervical block anesthesia
IV regional anesthesia (Bier Block)
Bupivacaine spinal
Severe hemorrhage, severe hypotension or shock and arrhythmias (eg, complete heart block)
Local infection at the site of proposed lumbar puncture
Septicemia
Intravenous regional anesthesia (Bier Block)
Obstetrical paracervical block anesthesia; its use in this technique has resulted in fetal bradycardia and death
Posimir
Undergoing obstetrical paracervical block anesthesia; use of bupivacaine HCl with this technique has resulted in fetal bradycardia and death
Adverse Effects
- Visible bruising (91.1%)
- Postprocedural contusion (14-71.2%)
- Nausea (20-55.8%)
- Surgical site bleeding (8.7-48.9%)
- Dizziness (15-40.3%)
- Somnolence (8.3-40%)
- Constipation (30.4%)
- Vomiting (4.4-29%)
- Bradycardia (22.9%)
- Headache (11.1-27.2%)
- Pruritus generalized (2.2-21.6%)
- Paresthesia (7.5-18.4%)
- Dysgeusia (13-17.6%)
- Hypoesthesia (17.3%)
- Anemia (4.5-16.7%)
- Tinnitus (13.2%)
- C-reactive protein increased (11.7%)
- Pyrexia (6-11.7%)
- Procedural pain (<11.4%)
- Dysuria (10.1%)
Warnings
Safety and effectiveness of local anesthetics depend on proper dosage, correct technique, adequate precautions, and readiness for emergencies; resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use
Caution with impaired cardiovascular function (eg, hypotension, heart block), as patients may be unable to compensate for functional changes associated with prolongation of AV conduction produced by bupivacaine; consider reduced dosing; closely monitor for blood pressure, heart rate, and ECG changes
Many drugs used during anesthesia may trigger malignant familial hyperthermia; potential for amide-type local anesthetics to also trigger such a response is unknown; consider a standard protocol for therapeutic management to be available
Avoid solutions containing antimicrobial preservatives, (ie, multiple-dose vials), for epidural or caudal anesthesia; safety not established for use
Infants and neonates are at greater risk for bupivacaine toxicity owing to a lower amount of serum alpha-1-acid-glycoprotein concentration compared with older children; this protein is the major binding site for bupivacaine, therefore, infants and neonates may have an increase of free fraction of local anesthetics
Bupivacaine is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with renal impairment; this should be considered when selecting the dosage
Because of long duration of anesthesia, when used for dental injections, warn patients about possibility of inadvertent trauma to tongue, lips, and buccal mucosa and advise them not to chew solid foods until sensation returns
Pregnancy and Lactation
Contraindicated for obstetrical paracervical block anesthesia; use has resulted in fetal bradycardia and death
Data are unavailable on use in pregnant women to inform a drug-associated risks of adverse developmental outcomes
Not studied in nursing mothers
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
Bupivacaine Hydrochloride
injectable solution
- 0.25% (Sensorcaine, Marcaine, generic)
- 0.5% (Sensorcaine, Marcaine, generic)
- Contains methylparaben
injectable solution, preservative-free
- 0.25% (Sensorcaine-MPF, Marcaine, generic)
- 0.5% (Sensorcaine-MPF, Marcaine, generic)
- 0.75% (Sensorcaine-MPF, Marcaine Preservative Free, generic)
injection, spinal
- 0.75% (Sensorcaine MPF Spinal, Marcaine Spinal, generic)
- Each 2-mL ampule contains 15 mg bupivacaine HCL with 165 mg dextrose
injection, single-dose vial
- 660mg/5mL (Posimir)
injectable suspension
- 133mg/10mL single-dose vial
- 266mg/20mL single-dose vial
surgical implant
- 100mg/implant
- Each single-dose package (pouch) contains 3 implants totaling 300 mg
