Index of drugs

Anesthesia with a long duration of action: exudative, peripheral nerves, epidural. The product is particularly recommended for the treatment of pain (eg during childbirth) due to a strong sensory blockage and a smaller movement block.

1 ml of solution contains 5 mg of bupivacaine hydrochloride and 5 μg of epinephrine in the form of tartrate.

Long-acting local anesthetic from the group of amides, containing adrenaline. In high doses it causes surgical anesthesia, in smaller ones it causes sensory blockage and less severe motor blockade. The beginning and duration of bupivacaine depend on the dose and place of administration. Adrenaline in the case of anesthesia and peripheral nerve anesthesia extends the duration of action, in the case of epidural anesthesia, the increase in the duration of action is lower. Bupivacaine reversibly inhibits the conduction of nerve impulses as a result of decreasing the permeability of the neuronal cell membrane to sodium ions. The concentration of bupivacaine depends on the dose administered, the route of administration and the vascularization of the site of administration. It binds to plasma proteins in 96%. Metabolized in the liver, about 1% of the dose is excreted in the urine in unchanged form. T_0,5 is 2.7 hours.

Hypersensitivity to local anesthetics from the amide group or other components of the drug. Hypersensitivity to methyl and / or propylparabydroxybenzoate (methyl / propylparaben) or its metabolite, paraaminobenzoic acid (PABA). Patients with hypersensitivity to esters of local anesthetics or their metabolites, PABA, should avoid using medicines containing bupivacaine and parabens. Hypersensitivity to sodium metabisulphate. Do not use bupivacaine in a piece of intravenous anesthesia (Bier's block), because inadvertent infiltration into the bloodstream may cause acute systemic toxicity.

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. 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; in patients with poor general condition, old age, when administering Next doses of the drug (risk of accumulation); in patients with advanced liver disease, severe renal failure, partial or total conduction block. Patients taking Class III antiarrhythmics should be carefully monitored (ECG) during anesthesia. Epidural - especially cautiously use in patients with hypovolaemia (risk of deepening hypotension). Carefully used for anesthesia in the head and neck (the risk of intra-arterial injection), retrobulbar and intraocular anesthesia, if there is a suspicion of a recent joint injury or the joint has undergone surgery. Because of the adrenaline supplement, use caution in patients with severe or untreated hypertension, poorly controlled hyperthyroidism, coronary heart disease, myocardial block, cerebral insufficiency, and advanced diabetes. Adrenaline-containing solutions should be used with caution in areas endowed with end arteries, e.g. fingers, or in areas with reduced blood supply for other reasons. The product contains sodium metabisulphate, and therefore may cause allergic reactions.

Do not use in early pregnancy, except if the benefits of anesthesia outweigh the risks. The effects of bupivacaine on the reproductive process in humans have not been demonstrated. When used in therapeutic doses, it passes into breast milk in small amounts, without creating a risk to the breast-fed child.

Side effects after anesthesia may be a result of the local anesthetic, a physiological response to the nerve blockade (hypotension, bradycardia), direct damage to the nerve associated with the puncture, indirect damage associated with puncture (eg subdural hematoma). During the use of the preparation may occur: very often - hypotension, nausea; often - bradycardia, hypertension, vomiting, paresthesia, dizziness, urinary retention; uncommon - toxic reactions on the part of the father: convulsions, numbness around the mouth, numbness of the tongue, hyperaesthesia, visual disturbances, loss of consciousness, muscle tremors, dizziness, tinnitus, speech impediment; rarely - neuropathy, peripheral nerve injury, arachnoiditis, cardiac arrest, arrhythmia, allergic reactions, anaphylactic shock, respiratory depression, diplopia.

Anesthesia can only be performed by a properly trained physician, with equipment and resuscitation medication.
Adults and adolescents from 12 years. Epidural anesthesia: lumbar for surgery - 75-150 mg bupivacaine (0.5% solution); lumbar caesarean section - 75-150 mg bupivacaine (0.5% solution); thoracic for surgery - 12.5-37.5 mg bupivacaine (2.5% solution), 25-50 mg bupivacaine (0.5% solution); cross-linked - 50-75 mg bupivacaine (2.5% solution), 100-150 mg bupivacaine (0.5% solution); peripheral nerve blockade 50-200 mg bupivacaine (0.5% solution); anesthesia, small nerve blockages - <150 mg bupivacaine (2.5% solution), ≤150 mg bupivacaine (0.5% solution). Treatment of acute pain, epidural lumbar: single dose - 15-37.5 mg bupivacaine (2.5% solution); continuous anesthesia - 12.5-18.8 mg bupivacaine / h (1.25% solution), 12.5-18.8 mg bupivacaine / h (1.25% solution); continuous anesthesia during labor - 6.25-12.5 mg bupivacaine / h (1.25% solution); epidural epidurals, continuous anesthesia - 6.3-12.5 mg bupivacaine / h (1.25% solution); 10-18,8 mg bupivacaine / h (2.5% solution); intraarticular anesthesia - ≤100 mg bupivacaine (2.5% solution); anesthesia, small nerve blockages - ≤150 mg bupivacaine (2.5% solution).Children 1-12 years old. Treatment of acute pain: epidural cross, lumbar, thoracic - 1.5-2 mg / kg bupivacaine (2.5% solution).
Aspiration should be performed before and during the administration of the drug, it is recommended to give a test dose (3-5 ml) with adrenaline (the occurrence of tachycardia facilitates the diagnosis of unintentional intravascular injection, and the occurrence of a nerve block facilitates the recognition of an unintentional subarachnoid injection); the main dose should be injected slowly (25-50 mg / min). In adults, do not exceed the single dose of 150 mg bupivacaine.