Bupivacaine

Bupivacaine is a prescription medication used as a local anesthetic (numbing medicine). Bupivacaine blocks the nerve impulses that send pain signals to your brain.

• Bupivacaine is available under the following different brand names: Marcaine and Sensorcaine.

Adult and Pediatric Dosages:

Injectable solution

• 0.25%
• 0.5%
• 0.75%

Dosage Considerations – Should be Given as Follows:

Local Anesthesia

Adult Dosage:

• Infiltration: 0.25% infiltrated locally: 175 mg maximum

Pediatric Dosage:

• Children under 12 years: not recommended
• Children over 12 years:
• Infiltration: 0.25% infiltrated locally: 175 mg maximum

Caudal Block

Adult Dosage:

• Preservative free: 15-30 ml of 0.25% or 0.5%

Pediatric Dosage:

• Children under 12 years: not recommended
• Children over 12 years: 15-30 ml of 0.25% or 0.5% (preservative free)v

Epidural Block Other Than Caudal Block

Adult Dosage:

• Preservative free: 10-20 ml of 0.25% or 0.5%; administer in 3-5 ml increments allowing sufficient time to detect toxic manifestations of inadvertent intravenous or intrathecal (IT) administration
• Surgical procedures requiring high degree of muscle relaxation and prolonged effects: 10-20 mL of 0.75%; not to be used in obstetrical cases

Pediatric Dosage:

• Children under 12 years: not recommended
• Children over 12 years: 10-20 ml of 0.25% or 0.5%; administer in 3-5 ml increments allowing sufficient time to detect toxic manifestations of inadvertent intravenous or IT administration (preservative free); for surgical procedures requiring high degree of muscle relaxation and prolonged effects administer 10-20 ml of 0.75%; not to be used in obstetrical cases

Peripheral Nerve Block

Adult Dosage:

• 5 ml of 0.25-0.5%; 400 mg/day maximum

Pediatric Dosage:

• Children under 12 years: not recommended
• Children over 12 years: 5 ml of 0.25-0.5%; 400 mg/day maximum

Sympathetic Nerve Block

Adult Dosage:

• 20-50 ml of 0.25%

Pediatric Dosage:

• Children under 12 years: not recommended
• Children over 12 years: 20-50 ml of 0.25%

Retrotubular Anesthesia

Adult Dosage:

• 2-4 ml of 0.75%

Pediatric Dosage:

• Children under 12 years: not recommended
• Children over 12 years: 20-50 ml of 0.25%

Spinal Anesthesia

Adult Dosage:

• Preservative free: 0.75% bupivacaine in 8.25% dextrose

Common side effects of bupivacaine include:

• abnormal heart rhythms
• anxiety
• apprehension
• back pain
• blurred vision
• cardiac arrest
• cardiovascular collapse
• chest pain
• chills or shivering
• confusion/disorientation
• convulsions (seizures)
• dizziness
• drowsiness
• constricted pupils
• fast heart rate
• feeling unusually hot
• gasping
• headache
• high blood pressure (hypertension [epinephrine-containing solutions])
• impaired heart function (myocardial depression)
• loss of consciousness
• low blood pressure (hypotension)
• metallic taste
• multiple asthma attacks (status asthmaticus)
• nausea
• numbness or tingling around your mouth
• strong, or irregular heartbeat
• restlessness
• ringing in the ears (tinnitus)
• severe allergic reaction (anaphylactoid reactions [sometimes fatal])
• slow breathing
• slow heart rate
• respiratory arrest
• swelling
• tremors (shaking)
• urinating less than usual or not at all
• vomiting
• weak or shallow breathing
• weak pulse

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

Bupivacaine has no known severe interactions with other drugs.

• Bupivacaine has no known serious interactions with other drugs.
• Moderate interactions of bupivacaine include:
  • benazepril
  • bupivacaine liposome
  • captopril
  • dofetilide
  • nadolol
  • nevirapine
  • pindolol
  • proprandolol
  • timolol
• Mild interactions of bupivacaine include:
  • hyaluronidase
• Bupivacaine has no known minor interactions with other drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more information about this medicine.

Warnings

• The 0.75% concentration of bupivacaine is not recommended for obstetrical anesthesia; cardiac arrest with difficult resuscitation or death reported when used as epidural anesthesia in obstetrical patients; reserve the 0.75% concentration for surgical procedures where a high degree of muscle relaxation and prolonged effect are necessary.
• Preservative-containing solutions should not be used for caudal or epidural blocks.
• This medication contains bupivacaine. Do not take Marcaine or Sensorcaine if you are allergic to bupivacaine or any ingredients contained in this drug.
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity, sensitivity to parabens.
• Obstetrical paracervical block anesthesia.
• Intravenous regional anesthesia use.

Effects of Drug Abuse

• None

Short-Term Effects

• See "What Are Side Effects Associated with Using Bupivacaine?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Bupivacaine?"

Cautions

• History of malignant hyperthermia.
• DO NOT use solutions with epinephrine in distal areas of the body (digit, nose, or ear).
• Use preservative-free preparations for spinal or epidural anesthesia.
• Avoid intravascular administration.
• The addition of a vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase the duration of action.
• Test dose recommended for epidural administration.
• Caution in cardiovascular disease including hypotension or heart block.
• Cardiac arrest, arrhythmia, and death were reported with the use of bupivacaine-containing products.
• Confusion, convulsions, respiratory depression, and/or respiratory arrest, and cardiovascular stimulation or depression were reported.
• Use caution in patients with hepatic impairment.
• Use caution in the elderly, the acutely ill, or debilitated patient (may require dose reduction).
• Chondrolysis associated with intra-articular infusions following arthroscopic and other surgical procedures (off-label use).

Pregnancy and Lactation

• Use bupivacaine with caution during pregnancy if the benefits outweigh the risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
• Bupivacaine excretion in breast milk is unknown. It is not recommended if breastfeeding.