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.
GENERIC AVAILABLE: Yes
PREPARATIONS: 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.
STORAGE: Bupivacaine should be stored at room temperature, between 20 C to 25 C (68 F to 77 F).
DOSING: 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.
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.
PREGNANCY: There are not adequate studies in pregnant women. It may be used for obstetrical anesthesia or analgesia if benefits outweigh the risks.
NURSING MOTHERS: Bupivacaine is excreted in breast milk and should not be used by nursing mothers.
Medically reviewed by Eni Williams, PharmD
REFERENCE: FDA Prescribing Information.
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