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1 sulfites and should be avoided in patients with known intolerance; OB: Obstetrical
paracervical block anesthesia.
PDF Page #1
bupivacaine (byoo-pi-vi-kane) Use Cautiously in: Concurrent use of other local anesthetics; Liver disease; Con-
Marcaine, Sensorcaine current use of anticoagulants (including low-dose heparin and low-molecular-
Classification weight heparins/heparinoids)qthe risk of spinal/epidural hematomas; Pedi: Chil-
dren 12 yr (safety not established).
Therapeutic: epidural local anesthetics, anesthetics (topical/local)
Pregnancy Category C Adverse Reactions/Side Effects
CNS: SEIZURES, anxiety, dizziness, headache, irritability. EENT: blurred vision, tinni-
Indications tus. CV: CARDIOVASCULAR COLLAPSE, arrhythmias, bradycardia, hypotension. GI: nau-
Local or regional anesthesia or analgesia for surgical, obstetric, or diagnostic proce- sea, vomiting. GU: urinary retention. Derm: pruritus. F and E: metabolic acidosis.
dures. Neuro: circumoral tingling/numbness, tremor. Misc: allergic reactions, fever.
Action Interactions
Local anesthetics inhibit initiation and conduction of sensory nerve impulses by alter- Drug-Drug: Additive toxicity may occur with concurrent use of other amide local
ing the influx of sodium and efflux of potassium in neurons, slowing or stopping pain anesthetics (including lidocaine, mepivacaine, and prilocaine). Use of solution
transmission. Therapeutic Effects: Decreased pain or induction of anesthesia; containing epinephrine with MAO inhibitors may cause hypertension.
low doses have minimal effect on sensory or motor function; higher doses may pro-
duce complete motor blockade. Route/Dosage
Pharmacokinetics Solutions containing preservatives should not be used for caudal or epidural blocks.
Absorption: Systemic absorption follows epidural administration, but amount ab- Epidural (Adults and Children 12 yr): 10 20 mL of 0.25% (partial to moder-
sorbed depends on dose. ate block), 0.5% (moderate to complete block), or 0.75% (complete block) solu-
Distribution: If systemic absorption occurs, this agent is widely distributed and tion. Administer in increments of 3 5 mL allowing sufficient time to detect toxic
crosses the placenta. signs/symptoms of inadvertent IV or IT administration. A test dose of 2 3 mL of 0.5%
Metabolism and Excretion: Small amounts that may reach systemic circulation with epinephrine solution is recommended prior to epidural blocks.
are mostly metabolized by the liver; 6% excreted unchanged in the urine. Caudal block (Adults and Children 12 yr): 15 30 mL of 0.25% or 0.5% solution.
Half-life: 1.5 5 hr (after epidural use). A test dose of 2 3 mL of 0.5% with epinephrine solution is recommended prior to
caudal blocks.
TIME/ACTION PROFILE (analgesia) Peripheral nerve block (Adults and Children 12 yr): 5 mL of 0.25% or 0.5% so-
ROUTE ONSET PEAK DURATION lution (maximum dose 400 mg).
Epidural 1030 min unknown 28 hr Sympathetic nerve block (Adults and Children 12 yr): 20 50 mL of 0.25% solu-
Duration of anesthetic block
tion.
Dental block (Adults and Children 12 yr): 1.8 3.6 mL per site of 0.5% with epi-
Contraindications/Precautions nephrine solution.
Contraindicated in: Hypersensitivity; cross-sensitivity with other amide local an- Local Infiltration (Adults and Children 12 yr): 0.25% solution infiltrated locally
esthetics may occur (ropivacaine, lidocaine, mepivacaine, prilocaine); Contains bi- (maximum dose 175 mg).
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.
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NURSING IMPLICATIONS PDF Page #2

Assessment
Systemic Toxicity: Assess for systemic toxicity (circumoral tingling and numb-
ness, ringing in ears, metallic taste, dizziness, blurred vision, tremors, slow
speech, irritability, twitching, seizures, cardiac dysrhythmias). Report to physician
or other health care professional.
Monitor BP, HR, and respiratory rate continuously while patient is receiving this
medication.
Monitor for return of sensation after procedure.

Potential Nursing Diagnoses

Patient/Family Teaching
Instruct patient to notify nurse if signs or symptoms of systemic toxicity occur.
Advise patient to request assistance during ambulation until orthostatic hypoten-
sion and motor deficits are ruled out.
Evaluation/Desired Outcomes
Decrease in postoperative pain without unwanted sensory or motor deficits.
Why was this drug prescribed for your patient?

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