Bupivacaine/Epinephrine

2
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

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