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Bupivacaine/Epinephrine

    Brands

    DEA Class;  Rx

    Common Brand Names; Marcaine, Marcaine Spinal, POSIMIR, Sensorcaine, Sensorcaine MPF, Xaracoll

    • Amide Local Anesthetics

    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

    For local anesthesia, including infiltration anesthesia.
    For regional anesthesia, including caudal anesthesia, epidural anesthesia, or obstetric anesthesia.
    For lumbar epidural block excluding obstetrical anesthesia.
    For lumbar epidural block in obstetrical anesthesia.
    For nerve block anesthesia, including peripheral nerve block and sympathetic nerve block.
    For peripheral nerve block.
    For spinal anesthesia, including Caesarean section anesthesia.
    For postsurgical local analgesia.
     

    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.

    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 / 

    –

    Bupivacaine is contraindicated in patients undergoing obstetrical paracervical nerve block anesthesia

     

    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.

    Adults

    175 mg/dose and 400 mg/24 hours for all parenteral routes; 300 mg/procedure for implant; 660 mg/procedure for subacromial space infiltration.

    Geriatric

    175 mg/dose and 400 mg/24 hours for all parenteral routes; 300 mg/procedure for implant; 660 mg/procedure for subacromial space infiltration.

    Adolescents

    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.

    Children

    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.

    Infants

    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.

    Neonates

    Safety and efficacy have not been established.

    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