bupivacaine

Pronunciation

Generic Name: bupivacaine (bue PIV a kane)
Brand Name: Marcaine HCl, Marcaine Spinal, Sensorcaine, Sensorcaine-MPF, Sensorcaine-MPF Spinal

What is bupivacaine?

Bupivacaine is an anesthetic (numbing medicine) that blocks the nerve impulses that send pain signals to your brain.

Bupivacaine is used as a local (in only one area) anesthetic.

Bupivacaine is given as an epidural injection into the spinal column to produce numbness during labor, surgery, or certain medical procedures.

Bupivacaine is also used as an anesthetic for dental procedures.

Bupivacaine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about bupivacaine?

Tell your doctor if you have ever had an allergic reaction to any type of numbing medicine.

Before receiving this medication, tell your doctor if you have kidney or liver disease, anemia (lack of red blood cells), a bleeding or blood clotting disorder, syphilis, polio, a brain or spinal cord tumor, numbness or tingling, chronic back pain, headache caused by surgery, low or high blood pressure, a curved spine, or arthritis.

Slideshow: 2014 Update - First Time Brand-to-Generic Switches

You will be watched closely after receiving bupivacaine, to make sure you do not have a reaction to the medication.

This medication can cause numbness over a large portion of your body. Take care to avoid injury before the feeling has returned completely. After a dental procedure, avoid eating, chewing gum, or drinking a hot beverage until your mouth is no longer numb.

Some epidural numbing medications can have long-lasting or permanent effects on certain body processes such as sexual function, bowel or bladder control, and movement or feeling in your legs or feet. Talk with your doctor about your specific risk of nerve damage from bupivacaine.

What should I discuss with my health care provider before receiving bupivacaine?

Tell your doctor if you have ever had an allergic reaction to any type of numbing medicine.

To make sure you can safely receive bupivacaine, tell your doctor if you have any of these other conditions:

  • anemia (lack of red blood cells);

  • kidney or liver disease;

  • a bleeding or blood clotting disorder;

  • syphilis, polio, a brain or spinal cord tumor;

  • numbness or tingling;

  • chronic back pain, headache caused by surgery;

  • low or high blood pressure;

  • curvature of the spine; or

  • arthritis.

FDA pregnancy category C. It is not known whether bupivacaine will harm an unborn baby. Tell your doctor if you are pregnant.

Bupivacaine can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using bupivacaine.

How is bupivacaine given?

Bupivacaine is injected through a needle directly into or near the area to be numbed. You will receive this injection in a dental or hospital setting.

For an epidural, bupivacaine is given as an injection through a needle placed into an area of your middle or lower back near your spine.

For a dental procedure, bupivacaine is injected directly into the mouth near the tooth or teeth your dentist will be working on.

Your breathing, blood pressure, oxygen levels, or other vital signs will be watched closely while you are receiving bupivacaine.

Some epidural numbing medications can have long-lasting or permanent effects on certain body processes such as sexual function, bowel or bladder control, and movement or feeling in your legs or feet. Talk with your doctor about your specific risk of nerve damage from bupivacaine.

What happens if I miss a dose?

Since bupivacaine is given as needed before a surgery or dental procedure, you are not likely to be on a dosing schedule.

What happens if I overdose?

Tell your caregivers right away if you think you have received too much of this medicine.

Overdose symptoms may include extreme drowsiness, fainting, or slowed breathing.

What should I avoid after receiving bupivacaine?

This medication can cause numbness over a large portion of your body. Take care to avoid injury before the feeling has returned completely.

After a dental procedure, avoid eating, chewing gum, or drinking a hot beverage until your mouth is no longer numb.

Bupivacaine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives, red rash, itching; sneezing, difficulty breathing; severe dizziness, vomiting; swelling of your face, lips, tongue, or throat.

Tell your caregivers at once if you have any of these serious side effects:

  • feeling anxious, restless, confused, or like you might pass out;

  • problems with speech or vision;

  • ringing in the ears, metallic taste, numbness or tingling around your mouth, or tremors;

  • seizure (convulsions);

  • weak or shallow breathing;

  • fast heart rate, gasping, feeling unusually hot;

  • slow heart rate, weak pulse;

  • urinating less than usual or not at all.

Less serious side effects include:

  • nausea, vomiting;

  • chills or shivering;

  • headache; or

  • back pain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Bupivacaine dosing information

Usual Adult Dose for Local Anesthesia:

Bupivacaine: Most experience to date is with single doses up to 175 mg; more or less drug may be used to individualize dose

Doses may be repeated up to once every 3 hours.
Maximum dose: 400 mg per 24 hours

Local infiltration:
0.25% concentration: Inject up to the maximum dose

Epidural block:
0.75% concentration: Inject 75 to 150 mg (10 to 20 mL) once for complete motor block; not for obstetrical anesthesia
0.5% concentration: Inject 50 to 100 mg (10 to 20 mL) for moderate to complete motor block; repeat doses increase the degree of motor block
0.25% concentration: Inject 25 to 50 mg (10 to 20 mL) for partial to moderate motor block; repeat doses increase the degree of motor block

Epidural anesthesia: 0.5% and 0.75% solutions should be administered in 3 to 5 mL increments with sufficient time between doses to detect toxicity or accidental intravascular or intrathecal injection

Epidural anesthesia in obstetrics: Only 0.5% and 0.25% concentrations should be used; 0.5% solution should be administered in 3 to 5 mL increments not exceeding 50 to 100 mg at any dosing interval; repeat doses should follow a test dose containing epinephrine if not contraindicated; preservative-free product should be used

Caudal block:
0.5% concentration: Inject 75 to 150 mg (15 to 30 mL) for moderate to complete motor block; repeat doses increase the degree of motor block
0.25% concentration: Inject 37.5 to 75 mg (15 to 30 mL) for moderate motor block; repeat doses increase the degree of motor block

Peripheral nerve block:
0.5% concentration: Inject 25 mg up to the maximum dose (5 mL up to the maximum dose) for moderate to complete motor block; repeat doses increase the degree of motor block
0.25% concentration: Inject 12.5 mg up to the maximum dose (5 mL up to the maximum dose) for moderate to complete motor block; repeat doses increase the degree of motor block

Retrobulbar block:
0.75% concentration: Inject 15 to 30 mg (2 to 4 mL) for complete motor block; repeat doses increase the degree of motor block

Sympathetic block:
0.25% concentration: Inject 50 to 125 mg (20 to 50 mL)

Bupivacaine in dextrose injection:
Spinal anesthesia: Inject 7.5 mg (1 mL) for lower extremity and perineal procedures (including transurethral resection of the prostate and vaginal hysterectomy); 12 mg (1.6 mL) has been used for lower abdominal procedures (such as abdominal hysterectomy, tubal ligation, and appendectomy); doses as low as 6 mg have been used for vaginal delivery

These dosages are recommended as a guide for use in an average adult.

Usual Adult Dose for Cesarean Section:

Bupivacaine in dextrose injection:
Spinal anesthesia: 7.5 to 10.5 mg (1 to 1.4 mL) has been used

Usual Pediatric Dose for Local Anesthesia:

Bupivacaine:

Epidural block:
1.25 mg/kg/dose (preservative free)

Caudal block:
1 to 3.7 mg/kg (preservative free)

Peripheral nerve block: 5 mL dose of 0.25% or 0.5% (12.5 to 25 mg); maximum dose: 400 mg/day.

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

Continuous epidural (caudal or lumbar) infusion (preservative free):
:

Loading dose: 2 to 2.5 mg/kg (0.8 to 1 mL/kg of 0.25% bupivacaine).

Infusion dose: Infants 4 months or younger: 0.2 to 0.25 mg/kg/h; Infants older than 4 months and children: 0.4 to 0.5 mg/kg/h.

Bupivacaine in dextrose injection: Not recommended in pediatric patients less than 18 years of age.

What other drugs will affect bupivacaine?

Tell your doctor about all other medicines you use, especially:

  • a blood thinner such as warfarin (Coumadin, Jantoven);

  • ergot medicine such as ergotamine (Ergomar, Cafergot, Migergot), dihydroergotamine (D.H.E. 45, Migranal), ergonovine (Ergotrate), or methylergonovine (Methergine);

  • antidepressants such as amitriptyline (Elavil, Vanatrip, Limbitrol), doxepin (Sinequan, Silenor), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), amitriptyline (Elavil, Vanatrip, Limbitrol), doxepin (Sinequan, Silenor), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil);

  • an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate); or

  • a phenothiazine such as chlorpromazine (Thorazine), fluphenazine (Permitil, Prolixin), perphenazine (Trilafon), prochlorperazine (Compazine, Compro), promethazine (Pentazine, Phenergan, Anergan, Antinaus), thioridazine (Mellaril), or trifluoperazine (Stelazine).

This list is not complete and other drugs may interact with bupivacaine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about bupivacaine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.01. Revision Date: 2012-06-15, 12:13:05 AM.

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