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 |
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Bupivacaine
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Bupivacaine Containing Brands
Bupivacaine is used in following diseases
Drug - Drug Interactions of Bupivacaine
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