Bupivacaine

Indications
 Injection
Percutaneous infiltration anaesthesia
Adult: 0.25% solution is typically used. For prolonged action: 9 mg (1.8 ml) of a 0.5% solution with adrenaline (1:200,000) can be admin, repeated once after 2-10 min if necessary. Max total: 90 mg/dental sitting. Max single dose: 150 mg with or without adrenaline, followed by 50 mg every 2 hr if needed.
Injection
Peripheral nerve block
Adult: 12.5 mg (5 ml) of a 0.25% solution or 25 mg (5 ml) of a 0.5% solution. Max single dose: 150 mg with or without adrenaline, followed by 50 mg every 2 hr if needed.
Injection
Sympathetic nerve block
Adult: 50-125 mg (20-50 ml) of a 0.25% solution.
Injection
Retrobulbar block
Adult: 15-30 mg (2-4 ml) of a 0.75% solution.
Injection
Caudal block
Adult: In surgery: 37.5-75 mg (15-30 ml) of a 0.25% solution or 75-150 mg (15-30 ml) of a 0.5% solution. With analgesia during labour: 25-50 mg (10-20 ml) of a 0.25% solution or 50-100 mg (10-20 ml) of a 0.5% solution.
Injection
Lumbar epidural block
Adult: In surgery: 25-50 mg (10-20 ml) of a 0.25% solution or 50-100 mg (10-20 ml) of a 0.5% solution. With analgesia during labour: 15-30 mg (6-12 ml) of a 0.25% solution or 30-60 mg (6-12 ml) of a 0.5% solution. In non-obstetric surgery: 75-150 mg (10-20 ml) of a 0.75% solution.

Special Populations: Reduce dose in children, elderly or debilitated patients and in cardiac or hepatic disease.
Contraindications
 Hypersensitivity to local anaesthetics of amide type. IV regional anaesthesia; paracervical block in obstetrics; spinal anaesthesia <18 yr. Lactation. Solutions containing preservatives for caudal or epidural block.
Warnings / Precautions
 Hepatic disease; CV disease; children <12 yr; pregnancy. Elderly and debilitated patients.
Adverse Reactions
 CNS excitation may be followed by depression. Hypotension, bradycardia, arrhythmias and cardiac arrest; methaemoglobinaemia; seizures, restlessness, dizziness. Hypersensitivity. Prolonged block.
Potentially Fatal: Cardiac and sudden respiratory arrest.
Overdose Reactions
 Management includes careful and constant monitoring of CV and respiratory vital signs and the patient's state of consciousness after each local anaesthetic inj. Establish and maintain a patent airway, oxygen may be needed. If necessary, drugs may be used to control convulsions. Hypotension may also be managed by giving IV fluids such as sodium chloride inj.
Drug Interactions
 Decreased duration with hyaluronidase. Decreased clearance with cimetidine and ranitidine. Potentiates lidocaine and mepivacaine. Allergic-type reactions with formulations containing sodium metabisulfite.
Potentially Fatal: May potentiate systemic toxicity of other local amide anaesthetics. Increased risk of myocardial depression with antiarrhythmics.
See Below for More bupivacaine Drug Interactions
Mechanism of Actions
 Bupivacaine blocks both the initiation and conduction of nerve impulses reducing the permeability of neuronal membranes to Na ions resulting in inhibition of depolarization with resultant blockade of conduction.
Onset: 4-10 min.
Duration: 1.5-8.5 hr.
Distribution: Crosses the placenta, diffuses into CSF, enters breast milk (small amounts). Protein-binding: 95%.
Metabolism: Hepatic.
Excretion: Urine (as metabolites); 1.5-5.5 hr (elimination half-life).
ATC Classification
 N01BB01 - bupivacaine ; Belongs to the class of amides. Used as local anesthetics.
Available As
  • Bupivacaine 0.25%
  • Bupivacaine 0.5 %
  • Bupivacaine 0.5%
  • Bupivacaine 1%
  • Bupivacaine 2.5 mg
  • Bupivacaine 5 mg

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