What is bupivicaine injection, and how does it work (mechanism of action)?
Bupivacaine is a local anesthetic that is similar to lidocaine and mepivacaine (amide type). Bupivacaine, like other local anesthetics reduces the flow of sodium in and out of nerves. This decreases the initiation and transfer of nerve signals in the area in which the drug is applied. This blockage leads first to a loss of sensation of pain, then temperature, touch, deep pressure, and muscle control. The concentration of the drug will determine how quickly it starts working. The FDA approved bupivacaine in October 1972.
What brand names are available for bupivicaine-injection?
Marcaine; Sensorcaine
Is bupivicaine-injection available as a generic drug?
Yes
Do I need a prescription for bupivicaine-injection?
Yes
What are the side effects of bupivicaine injection?
Side effects are related to higher doses, as well as unintentional injection into alternative sites. Absorption into the blood stream may lead to the following sied effects:
- low blood pressure,
- slow heart rate,
- strong or irregular heartbeat,
- and cardiac arrest.
Other important side effects include:
- nausea,
- vomiting,
- fecal and urinary incontinence,
- loss of sexual function,
- blurred vision,
- ringing in the ears, and
- loss of joint cartilage.
Rare, but serious complications include decreased function of the nervous system, activation of the nervous system (resulting in seizures), paraplegia, nerve disorder, total block of spinal nerves, and respiratory arrest. Specific warnings exist about using the 0.75 % dose in obstetrical anesthesia as there have been reports of cardiac arrest.
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What is the dosage for bupivicaine injection?
The initial dose for adults depends on the procedure, necessary depth of anesthesia, blood flow to the region, desired duration of anesthesia, and the condition of the patient. For example, in surgical procedures requiring a high degree of muscle relaxation and prolonged effects, 10-20 mL of 0.75% bupivacaine should be administered. Smaller procedures will require smaller doses.
Which drugs or supplements interact with bupivicaine injection?
Therapy should be monitored when used with beta-blockers, such as atenolol (Tenormin), as they may increase the concentration of bupivacaine.
Monitor therapy with peginterferon Alfa-2b as it may decrease the concentration of bupivacaine and lead to diminished effects.
Hyaluronidase may increase how quickly bupivacaine starts to work as well as increase how much bupivacaine is absorbed into the blood stream. Monitor for toxic reactions such as low blood pressure, decreased heart rate, irregular heart rhythm, or cardiac arrest.
Technetium Tc 99m tilmanocept should not be simultaneously injected with the bupivacaine as it interferes with how well the technetium Tc 99m tilmanocept is able to spread and be used for diagnostic purposes.
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Is bupivicaine injection safe to take if I’m pregnant or breastfeeding?
There are not adequate studies in pregnant women. It may be used for obstetrical anesthesia or analgesia if benefits outweigh the risks.
Bupivacaine is excreted in breast milk and should not be used by nursing mothers.
What else should I know about bupivicaine injection?
What preparations of bupivicaine-injection are available?
Intrathecal solution and injection solution with or without methylparaben and or preservatives: 0.25%, 0.5%, 0.75% in 2, 10, 30, 50 mL. Preservative free formulations should be used in caudal or epidural block.
How should I keep bupivicaine-injection stored?
Bupivacaine should be stored at room temperature, between 20 C to 25 C (68 F to 77 F).