A subarachnoid anesthesia. Urological procedures, treatments in the lower limbs (if the procedure lasts for 2-3 hours) or abdominal surgery (if the procedure lasts 45-60 min).
Composition:
1 ml of solution contains 5 mg of bupivacaine hydrochloride.
Action:
Localized anesthetic agent with amide structure. Reversibly inhibits the nerve conduction in nerve fibers by reducing the permeability of the cell membrane to sodium ions. When administered into the subarachnoid space, it is characterized by a rapid onset of action and a medium-long or long blocking time. The preparation is a hyperbaric solution in relation to the cerebrospinal fluid. Bupivacaine after subarachnoid administration is completely absorbed from the subarachnoid space by two phases. The half-life in two phases is 50 and 408 min, respectively. The blood concentration of bupivacaine is relatively small when administered into the subarachnoid space compared to other types of blockades: after administration of 20 mg of the drug, the plasma concentration is about 0.1 mg / ml. Bupivacaine is metabolised in the liver mainly to 2,6-pipecolyloxidine (PPX) and its derivatives. Only 6% of the dose is excreted in the urine in unchanged form.
Contraindications:
Hypersensitivity to bupivacaine, topical anesthetics with amide structure or other components of the preparation. Regardless of the local anesthetic used, spinal anesthesia is contraindicated in the following situations: acute CNS diseases (eg meningitis, tumors, gray matter of the spinal cord, intracranial bleeding); narrowing of the spinal cord, active diseases (eg inflammatory processes in the spine, tumors), or recent spinal injuries (eg fractures); sepsis; subacute spinal cord degeneration in the course of pernicious anemia; skin infection at the site of anesthesia or in its vicinity; cardiogenic or hypovolemic shock, coagulation disorders or treatment with anticoagulants.
Precautions:
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. Use cautiously in patients with poor general condition, elderly, in advanced pregnancy, with atrioventricular block IIst. or III., advanced liver disease, severe renal failure. Patients taking Class III antiarrhythmics should be carefully monitored (ECG) during anesthesia. In elderly or more advanced patients, there is a greater risk of high or complete spinal anesthesia (lower doses are recommended). Caution in patients with hypovolaemia (risk of deepening hypotension); with neurological disorders (MS, hemiplegia, transverse paralysis, neuromuscular disorders).
Pregnancy and lactation:
Do not use in early pregnancy, except if the benefits of anesthesia outweigh the risks; in advanced pregnancy, the dose should be reduced. 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:
Side effects after subarachnoid anesthesia may be the result of a local anesthetic, a physiological response to nerve conduction block (hypotension, bradycardia, urination disorders), direct damage due to puncture (eg hematoma), indirect puncture damage (e.g., meningitis) cerebrospinal fluid, epidural abscess) or cerebrospinal fluid leak after needle puncture (e.g., post-operative headache). During the use of the preparation may occur: very common (> 1/10) - hypotension, bradycardia, nausea; often (> 1/100, <1/10) - post-operative headaches, vomiting, urination disorders, incontinence; not often (> 1/1000, <1/100) - paresthesia, paresis, dysentesis, muscle weakness, backache; rarely (<1/1000) - cardiac arrest, allergic reactions, anaphylactic shock, unintentional total spinal anesthesia, paraplegia and other paralysis, neuropathy, arachnoiditis, respiratory disorders.
Dosage:
The dose depends on the weight and height of the patient, the technique of anesthesia, the patient's position, the expected area under anesthesia.Spinal anesthesia for surgical procedures in the lower limbs and hip joint and in the abdominal cavity (also for caesarean section): the recommended dose is 2-4 ml of the preparation (10-20 mg). A subarachnoid anesthesia for urological procedures: the recommended dose is 1.5-3 ml of the preparation (7.5-15 mg). Volume of more than 4 ml is not recommended. Regardless of the type of local anesthetic given - the range of segments under anesthesia is individual for a given patient and difficult to predict before anesthesia.
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