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SENSORCAINE WITH EPINEPHRINE is a brand name for Epinephrine (also known as Adrenaline), supplied as a solution. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: SENSORCAINE (bupivacaine hydrochloride) and SENSORCAINE with Epinephrine (bupivacaine hydrochloride and epinephrine) are indicated for the production of local or regional anaesthesia or analgesia with the following procedures: • Local infiltration • Peripheral minor or major nerve blocks • Epidural block for surgery •…
Verbatim from this product's HC label. Tap a section to expand.
2 Geriatrics Geriatrics (> 65 years of age): Elderly patients should be given reduced doses commensurate with their age and physical condition. 2 CONTRAINDICATIONS SENSORCAINE (bupivacaine hydrochloride) and SENSORCAINE with Epinephrine are contraindicated: In patients who are hypersensitive to this drug or to any ingredient in the formulation, including any non-medicinal ingredient, or component of the container.
For a complete listing, see
and 7 WARNINGS AND PRECAUTIONS). Central nervous system reactions are similar for all amide local anaesthetics, while cardiac reactions are more dependent on the drug, both quantitatively and qualitatively. Symptoms Accidental intravascular injections of local anaesthetics may cause immediate (within seconds to a few minutes) systemic toxic reactions.
In the event of overdose, systemic toxicity appears later (15-60 minutes after injection) due to the slower increase in local anaesthetic blood concentration. Central nervous system toxicity is a graded response with symptoms and signs of escalating severity.
The first symptoms are usually circumoral paresthesia, numbness of the tongue, light- headedness, hyperacousis, tinnitus and visual disturbances. Dysarthria, muscular twitching or tremors are more serious and precede the onset of generalized convulsions.
These signs must not be mistaken for a neurotic behaviour. Unconsciousness and grand mal convulsions may follow which may last from a few seconds to several minutes. Hypoxia and hypercarbia occur rapidly following convulsions due to the increased muscular activity, together with the interference with normal respiration and loss of the airway.
In severe cases apnoea may occur. Acidosis, hyperkalaemia, hypocalcaemia and hypoxia increase and extend the toxic effects of local anaesthetics. Recovery is due to redistribution and subsequent metabolism and excretion of the local anaesthetic drug.
Recovery may be rapid unless large amounts of the drug have been administered. Cardiovascular system toxicity may be seen in severe cases and is generally preceded by signs of toxicity in the central nervous system. In patients under heavy sedation or receiving a general anaesthetic, prodromal CNS symptoms may be absent.
Hypotension, bradycardia, arrhythmia and even cardiac arrest may occur as a result of high systemic concentrations of local anaesthetics, but in rare cases cardiac arrest has occurred without prodromal CNS effects. Cardiovascular toxic reactions are usually related to depression of the conduction system of the heart and myocardium, leading to decreased cardiac output, hypotension, heart block, bradycardia and sometimes ventricular arrhythmias, including ventricular tachycardia, ventricular fibrillation and cardiac arrest.
2 Geriatrics Geriatrics (> 65 years of age): Elderly patients should be given reduced doses commensurate with their age and physical condition. 2 CONTRAINDICATIONS SENSORCAINE (bupivacaine hydrochloride) and SENSORCAINE with Epinephrine are contraindicated: In patients who are hypersensitive to this drug or to any ingredient in the formulation, including any non-medicinal ingredient, or component of the container.
For a complete listing, see 6 DOSAGE FORMS, STRENGTHS, COMPOSITION AND PACKAGING. In patients with hypersensitivity to any local anaesthetic agent of the amide type. For intravenous regional anaesthesia (Bier block) since unintentional leakage of bupivacaine over the tourniquet may cause systemic toxic reactions.
Cardiac arrest and death have occurred (see 4 DOSAGE AND ADMINISTRATION). < SENSORCAINE®>< Bupivacaine Hydrochloride> Page 5 of 36 < SENSORCAINE® with Epinephrine> <Bupivacaine Hydrochloride and Epinephrine> In obstetric paracervical block anaesthesia.
Use of other local anaesthetics in this technique has resulted in foetal bradycardia and death. SENSORCAINE with Epinephrine is contraindicated: in patients with a hypersensitivity to sodium metabisulfite (see 6 DOSAGE FORMS, STRENGTHS, COMPOSITION AND PACKAGING, 7 WARNINGS AND PRECAUTIONS, Sensitivity/resistance).
1 Dosing Considerations General The dosage varies and depends upon the area to be anaesthetized, the number of neuronal segments to be blocked, the depth of anaesthesia and degree of muscle relaxation required, individual tolerance, tissue vascularity, and the technique of anaesthesia.
The lowest concentration of anaesthetic and the lowest dosage needed to provide effective anaesthesia should be administered. The rapid injection of a large volume of local anaesthetic solution should be avoided and fractional doses should be used when feasible.
In general, complete block of all nerve fibres in large nerves requires the higher concentrations of drug. , in the relief of labour pain), the lower concentrations are indicated. The volume of drug used will affect the extent of spread of anaesthesia.
SENSORCAINE (bupivacaine hydrochloride) and SENSORCAINE with Epinephrine are contraindicated: In patients who are hypersensitive to this drug or to any ingredient in the formulation, including any non-medicinal ingredient, or component of the container.
For a complete listing, see 6 DOSAGE FORMS, STRENGTHS, COMPOSITION AND PACKAGING. In patients with hypersensitivity to any local anaesthetic agent of the amide type. For intravenous regional anaesthesia (Bier block) since unintentional leakage of bupivacaine over the tourniquet may cause systemic toxic reactions.
Cardiac arrest and death have occurred (see
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Epinephrine in Canada.
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Brand names are compiled from public regulatory records for active-ingredient mapping only. Drugvu is not affiliated with any manufacturer. This is not medical advice.
< SENSORCAINE®>< Bupivacaine Hydrochloride> Page 11 of 36 < SENSORCAINE® with Epinephrine> <Bupivacaine Hydrochloride and Epinephrine> In children, early signs of local anaesthetic toxicity may be difficult to detect in cases where the block is given during general anaesthesia.
Treatment The first consideration is prevention, best accomplished by careful and constant monitoring of cardiovascular and respiratory vital signs and the patient’s state of consciousness after each local anaesthetic injection. If signs of acute systemic toxicity appear, injection of the local anaesthetic should be immediately stopped.
The first step in the management of systemic toxic reactions, as well as underventilation or apnoea due to unintentional subarachnoid injection of drug solution, consists of immediate attention to the establishment and maintenance of a patent airway and assisted or controlled ventilation with 100% oxygen and a delivery system capable of permitting immediate positive airway pressure by mask or endotracheal intubation.
This may prevent convulsions if they have not already occurred. CNS symptoms (convulsion, CNS depression) must promptly be treated with appropriate airway/ respiratory support and the administration of anticonvulsant drugs. If cardiovascular depression occurs (hypotension, bradycardia), appropriate treatment with intravenous fluids, vasopressors and/or inotropic agents should be considered as per standard practice guidance.
Children should be given appropriate treatment in doses commensurate with their age and weight. Should cardiac arrest occur, immediate cardiopulmonary resuscitation should be instituted. Optimal oxygenation and ventilation and circulatory support as well as treatment of acidosis are of vital importance, since hypoxia and acidosis will increase the systemic toxicity of local anaesthetics.
A successful resuscitation may require prolonged efforts. Lipid emulsion formulations should be made immediately available as part of the anaesthetic emergency preparedness in the health care facility. When symptoms and signs of local anaesthetic system toxicity are observed, lipid emulsion therapy should be considered if clinical events warrant intervention and after the airway is secured.
The supine position is dangerous in pregnant women at term because of aortocaval compression by the gravid uterus. Therefore, during treatment of systemic toxicity, maternal hypotension or foetal bradycardia following regional block, the parturient should be maintained in the left lateral decubitus position if possible, or manual displacement of the uterus off the great vessels should be accomplished.
Resuscitation of obstetrical patients may take longer than resuscitation of nonpregnant patients and closed-chest cardiac compression may be ineffective. Rapid delivery of the foetus may improve the response to resuscitative efforts.
For management of a suspected drug overdose, contact your regional poison control centre. 5 and 5 mg/mL bupivacaine hydrochloride SENSORCAINE with Epinephrine also contains sodium metabisulfite Solutions with epinephrine contain 5 mcg/mL (1:200,000) epinephrine as bitartrate Dosage Forms SENSORCAINE (bupivacaine […]
The use of bupivacaine with epinephrine will prolong the anaesthetic action. There have been adverse event reports of irreversible chondrolysis in patients receiving intra-articular infusions of local anaesthetics following arthroscopic and other surgical procedures.
SENSORCAINE (bupivacaine hydrochloride) is not approved for this use (see 7 WARNINGS AND PRECAUTIONS, General). Special Populations Local anaesthetics should be used with caution in patients in poor general condition due to aging or other compromising factors such as advanced liver disease or severe renal dysfunction although regional anaesthesia is frequently indicated in these patients.
2 Recommended Dose and Dosage Adjustment Adults: The dosages in Table 1 are recommended as a guide for use in the average adult for the more commonly used techniques. The clinician’s experience and knowledge of the patient’s physical condition are of importance in calculating the required dose.
< SENSORCAINE®>< Bupivacaine Hydrochloride > Page 6 of 36 < SENSORCAINE® with Epinephrine> <Bupivacaine Hydrochloride and Epinephrine> When prolonged blocks are used, the risks of reaching a toxic plasma concentration or inducing a local neural injury must be considered.
The maximum dosage limit must be determined by evaluating the size and physical condition of the patient and considering the usual rate of systemic absorption from a specific injection site. Experience to date indicates that 400 mg administered over 24 hours is well tolerated in average adults.
Until further experience is gained, this dose should not be exceeded in 24 hours. In order to avoid intravascular injection, aspiration should be repeated prior to and during administration of the main dose, which should be injected slowly or in incremental doses, at a rate of 25-50 mg/min, while closely observing the patient’s vital functions and maintaining verbal contact.
An inadvertent intravascular injection may be recognized by a temporary increase in heart rate and an accidental intrathecal injection by signs of a spinal block. If toxic symptoms occur, the injection should be stopped immediately.
Intra-articular Infusion of a local anaesthetic is an unapproved use (See 7 WARNINGS AND PRECAUTIONS). Sympathetic stellate block requires utmost caution (See 7 WARNINGS AND PRECAUTIONS, Injection in head and neck area). SENSORCAINE with Epinephrine (3 – 5 mL) should be used only as a test dose for epidural block in labour analgesia.
1 Pregnant Women). Table 1-Dosage recommendations in adults for SENSORCAINE or SENSORCAINE with Epinephrine TYPE OF BLOCK CONC. 25 up to 60b up to 150b 1-3 3-4 Surgical operations and postoperative analgesia. 5 up to 30b up to 150b 1-3 4-8 < SENSORCAINE®>< Bupivacaine Hydrochloride> Page 7 of 36 < SENSORCAINE® with Epinephrine> <Bupivacaine Hydrochloride and Epinephrine> TYPE OF BLOCK CONC.
5 75-150 2-5 15-30 1-2 2-3 Surgical operations Postoperative analgesia Caesarean section. 5-2 Surgical operations. 5 20-30 20-30 50-75 100- 150 20-30 15-30 1-2 2-3 Surgical operations and postoperative analgesia. Pain relief and diagnostic use.
5 2-3 10-15 3-5 4-8 Pain relief for surgery, postoperative and trauma. 5 30 150 15-30 4-8 Surgical operations. Sciatic […]
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