Yes

Local Anesthetic

Local anesthetic (injectable) for peripheral nerve block, infiltration, sympathetic block, caudal or epidural block, retrobulbar block

C

Hypersensitivity to bupivacaine hydrochloride or any component, para-aminobenzoic acid or parabens

Use with caution in patients with liver disease. Some commercially available formulations contain sodium metabisulfite, which may cause allergic-type reactions. Pending further data, should not be used in children <12 years of age and the solution for spinal anesthesia should not be used in children <18 years of age. Do not use solutions containing preservatives for caudal or epidural block; convulsions due to systemic toxicity leading to cardiac arrest have been reported, presumably following unintentional intravascular injection. 0.75% is not recommended for obstetrical anesthesia.

1% to 10% (dose related):

Central nervous system: Seizures, restlessness, anxiety, dizziness

Gastrointestinal: Nausea, vomiting

Neuromuscular & skeletal: Weakness

Ocular: Blurred vision

Otic: Tinnitus

Respiratory: Apnea

Treatment is primarily symptomatic and supportive. Termination of anesthesia by pneumatic tourniquet inflation should be attempted when the agent is administered by infiltration or regional injection

Bradyarrhythmias (when the heart rate is <60) can be treated with I.V., or S.C. atropine 15 mcg/kg

With the development of metabolic acidosis, I.V. sodium bicarbonate 0.5-2 mEq/kg and ventilatory assistance should be instituted

Methemoglobinemia should be treated with methylene blue 1-2 mg/kg in a 1% sterile aqueous solution I.V. push over 4-6 minutes repeated up to a total dose of 7 mg/kg.

Increased effect: Hyaluronidase

Increased toxicity: Beta-blockers, ergot-type oxytocics, MAO inhibitors, TCAs, phenothiazines, vasopressors

Solutions with epinephrine should be protected from light

Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction

Onset of anesthesia (dependent on route administered): Within 4-10 minutes generally

Duration of action: 1.5-8.5 hours

Metabolism: In the liver

Half-life (age dependent): Neonates: 8.1 hours; Adults: 1.5-5.5 hours

Elimination: Small amounts (~6%) excreted in urine

Dose varies with procedure, depth of anesthesia, vascularity of tissues, duration of anesthesia and condition of patient. Metabisulfites (in epinephrine-containing injection); do not use solutions containing preservatives for caudal or epidural block.

Children: 1-3.7 mg/kg

Adults: 15-30 mL of 0.25% or 0.5%

Epidural block (other than caudal block):

Children: 1.25 mg/kg/dose

Adults: 10-20 mL of 0.25% or 0.5%

Peripheral nerve block: 5 mL dose of 0.25% or 0.5% (12.5-25 mg); maximum: 2.5 mg/kg (plain); 3 mg/kg (with epinephrine); up to a maximum of 400 mg/day

Sympathetic nerve block: 20-50 mL of 0.25% (no epinephrine) solution

Solutions containing preservatives should not be used for epidural or caudal blocks

Monitor fetal heart rate during paracervical anesthesia

May cause anxiety and restlessness

Use with caution in patients receiving phenothiazines, MAOIs, or TCAs; severe hypertension or hypotension may result

No information available to require special precautions

No effects or complications reported

This medication is given to reduce sensation in the injected area. You will experience decreased sensation to pain, heat, or cold in the area and/or decreased muscle strength (depending on area of application) until the effects wear off; use necessary caution to reduce incidence of possible injury until full sensation returns. If used in mouth, do not eat or drink until full sensation returns. Immediately report chest pain or palpitations; increased restlessness, anxiety, or dizziness; skeletal or muscle weakness; difficulty breathing; ringing in ears; or changes in vision. Pregnancy/breast-feeding precautions: Inform prescriber if you are pregnant. Do not breast-feed.

Injection, as hydrochloride: 0.25% (10 mL, 20 mL, 30 mL, 50 mL); 0.5% (10 mL, 20 mL, 30 mL, 50 mL); 0.75% (2 mL, 10 mL, 20 mL, 30 mL)

Injection, as hydrochloride, with epinephrine (1:200,000): 0.25% (10 mL, 30 mL, 50 mL); 0.5% (1.8 mL, 3 mL, 5 mL, 10 mL, 30 mL, 50 mL); 0.75% (30 mL)

Lehmann LJ and Pallares VS, "Subdural Injection of a Local Anesthetic With Steroids: Complication of Epidural Anesthesia," South Med J, 1995, 88(4):467-9.

Long WB, Rosenblum S, and Grady IP, "Successful Resuscitation of Bupivacaine-Induced Cardiac Arrest Using Cardiopulmonary Bypass," Anesth Analg, 1989, 69(3):403-6.

Scott DB, Lee A, Fagan D, et al, "Acute Toxicity of Ropivacaine Compared With That of Bupivacaine," Anesth Analg, 1989, 69(5):563-9.

Sun KO, "Convulsion Following Spinal Anaesthesia," Anaesth Intensive Care, 1995, 23(4):520-1.

Tuominen MK, Pere P, and Rosenberg PH, "Unintentional Arterial Catheterization and Bupivacaine Toxicity Associated With Continuous Interscalene Brachial Plexus Block," Anesthesiology, 1991, 75(2):356-8.