Index of drugs

Local anesthesia in surgery, obstetrics and diagnostic and therapeutic procedures. The solution is used in anesthesia: infiltration, peripheral nerves, epidural nerves.

1 ml contains 5 mg of bupivacaine hydrochloride.

Local anesthetic agent from the group of amides. It inhibits the conductivity in sensory fibers rather than motor fibers (it is recommended in situations where sensory blockage without motion blockage is necessary). Bupivacaine is characterized by a rapid onset of action and a long-lasting effect - depending on the dose of the drug used. T_0,5 is 3.5 hours. It is metabolized mainly in the liver (the main metabolite is pipecoloxylidin). Bupivacaine and its metabolites are mainly excreted in the urine as metabolites conjugated to glucuronic acid; only 6% of the dose is excreted in the urine in unchanged form.

Hypersensitivity to the components of the preparation or other local anesthetics with amide structure. Cardiogenic and hypovolemic shock. Sectional intravenous anesthesia. Some conditions that contraindicate the use of epidurals, regardless of the type of local anesthetic used: meningitis, spinal cord inflammation, intracranial hemorrhage, subacute spinal degeneration in the course of pernicious anemia, brain and spinal cord tumors, spinal tuberculosis , purulent skin infection at the site of intended administration, clotting disorder or current anticoagulant therapy.

The medicine can only be used by a physician experienced in blocking, diagnosing acute toxic symptoms and treating side effects, in conditions of oxygen therapy and resuscitation, in centers employing trained personnel. Vaginal administration should be strictly avoided. Patients taking Class III antiarrhythmics should be carefully monitored (ECG) during anesthesia. Special care should be taken in the anesthesia of large nerve trunks and other techniques - when it is necessary to give a large volume of the drug; when administering the Next doses of the drug (risk of accumulation); in patients with cardiovascular insufficiency (less possibilities to compensate for changes associated with prolongation of the atrioventricular conduction time); in patients with liver problems and reduced hepatic flow. Carefully used for anesthesia in the head and neck (the risk of intra-arterial administration), for retrobulbar anesthesia. Epidural - especially cautiously used in patients with hypovolaemia, with disturbed venous return (ascites, abdominal tumor, advanced pregnancy), with pleural effusion (epidural anesthesia may cause temporary intercostal muscle dysfunction).

The preparation should not be used in early pregnancy, except when in the doctor's opinion the benefit to the mother outweighs the potential risk to the fetus. Bupivacaine is excreted in breast milk in a quantity not affecting the condition of the child being fed.

Side effects of the drug are associated with a general action after getting into the circulation. Cardiovascular system: bupivacaine affects the conduction system and the myocardium - it may cause decreased cardiac output, conduction block, hypotension, bradycardia, ventricular arrhythmias (including ventricular tachycardia, ventricular fibrillation and asystole). Central nervous system: numbness of the tongue, limited contact with the patient, dizziness, blurred vision, muscle tremors, drowsiness, convulsions, loss of consciousness, apnea. Significant toxic reactions with seizures and cardiac arrest have been reported after intravascular administration. Dependent on the technique of anesthesia - hypotension, bradycardia, vaso-valency, asystole; the so-called.high spinal anesthesia (after mistaken subarachnoid administration) with apnea and severe hypotension; mechanical damage to the spinal cord or nerve roots (with sensory disturbances, motor dysfunctions, sphincter dysfunction, paraplegia). After repeated administration or prolonged infusion hepatic function may be impaired with reversible elevation of aminotransferases, alkaline phosphatase and bilirubin.

Dosage is determined individually for each patient; the dose and concentration depend on the technique of anesthesia, the size of the anesthetized area, vascularization in the region of drug delivery, the required degree of motor blockage, the desired duration of anesthesia, clinical condition of the patient, the number of anesthetized segments under epidural anesthesia. The maximum single dose: 150 mg (adults). When using repeated doses - maximum of 50 mg every 2 hours. General dosing rules: adventitious anesthesia: maximum 60 ml 0.25% (= maximum 150 mg); lumbar epidural anesthesia for surgery: 10-20 ml 0.5% (= 50-100 mg) partial movement blockage to total, lumbar epidural anesthesia at delivery: 6-12 ml 0.5% (= 30-60 mg) blockade partial motor to total or 6-12 ml 0.25% (= 15-30 mg) minimal motor block; cross-epidural anesthesia for surgery: 15-30 ml 0.5% (= 75-150 mg) partial to total interventional block, epidural cross-contraction of children up to 10 years - level of anesthesia to Th₁₀0.3-0.4 ml / kg 0.25% (= 0.75-1 mg / kg), cross-spinal anesthesia for children up to 10 years - level of anesthesia to Th₆0.4-0.6 ml / kg 0.25% (= 1-1.5 mg / kg), cross-type epidural anesthesia during labor: 10-20 ml 0.5% (= 50-100 mg) immobilization partial to total or 10-20 ml 0.25% (= 25-50 mg) partial movement lock; peripheral nerve blockage: maximum 30 ml 0.5% (= maximum 150 mg) partial movement blockage to a total or maximum of 60 ml 0.25% (= maximum 150 mg) minimal to partial motor block; sympathetic block: 20-50 ml 0.25% (= 50-125 mg).
Perform a test aspiration before and during the administration of the drug, in the case of administration of large volumes - give a test dose (3-5 ml) with adrenaline (the occurrence of tachycardia then facilitates recognition of an intra-vascular injection); the main dose should be injected slowly (25-50 mg / min). In elderly patients, in poor general condition, in children - the dose should be reduced. In order to obtain a lower concentration of the preparation, dilute the solution with 0.9% NaCl solution or 5% Glucose solution.