BUPIVACAINE HEAVY

Adults and children above 12 years of age The doses recommended below should be regarded as a guide for use in the average adult. The figures reflect the expected average dose range needed. Standard textbooks should be consulted for factors affecting specific block techniques and for individual patient requirements.

The clinician’s experience and knowledge of the patient’s physical status are of importance in calculating the required dose. The lowest dose required for adequate anaesthesia should be used. Individual variations in onset and duration occur, and the extent of the spread of anaesthesia may be difficult to predict, but will be affected by the volume of the drug used, especially with the isobaric (plain) solution.

Dosage recommendations Intrathecal anaesthesia for surgery: 2-4 ml (10-20 mg bupivacaine hydrochloride). The dose should be reduced in the elderly and in patients in the late stages of pregnancy, see Section

Tabulated list of adverse reactions The adverse reaction profile for Bupivacaine injection is similar to those for other long acting local anaesthetics used for intrathecal anaesthesia. Frequencies are defined as very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to<1/1,000), very rare (<1/10,000) or not known (cannot be estimated from the available data).

g. g. g. g. postdural puncture headache). Acute systemic toxicity Bupivacaine injection, used as recommended, is not likely to cause blood levels high enough to cause systemic toxicity. However, if other local anaesthetics are concomitantly administered, toxic effects are additive and may cause systemic toxic reactions.

Systemic toxicity is rarely associated with spinal anaesthesia but might occur after accidental intravascular injection. Systemic adverse reactions are characterised by numbness of the tongue, light-headedness, dizziness and tremors, followed by convulsions and cardiovascular disorders.

Treatment of acute systemic toxicity No treatment is required for milder symptoms of systemic toxicity but if convulsions occur then it is important to ensure adequate oxygenation and to arrest the convulsions if they last more than 15–30 seconds.

Oxygen should be given by face mask and the respiration assisted or controlled if necessary. Convulsions can be arrested by injection of thiopental 100–150 mg intravenously or with diazepam 5– 10 mg intravenously. Alternatively, succinylcholine 50–100 mg intravenously may be given but only if the clinician has the ability to perform endotracheal intubation and to manage a totally paralysed patient.

High or total spinal blockade causing respiratory paralysis should be treated by ensuring and maintaining a patent airway and giving oxygen by assisted or controlled ventilation. g. ephedrine 10–15 mg intravenously and repeated until the desired level of arterial pressure is reached.

4. Neonates, infants and children up to 40 kg Bupivacaine injection may be used in children. One of the differences between small children and adults is a relatively high CSF volume in infants and neonates, requiring a relatively larger dose/kg to produce the same level of block as compared to adults.

Paediatric regional anaesthesia procedures should be performed by qualified clinicians who are familiar with this population and the techniques. The doses in the table should be regarded as guidelines for use in paediatric patients.

Individual variations occur. Standard textbooks should be consulted for factors affecting specific block technique and for individual patient requirements. The lowest dose required for adequate anaesthesia should be used. 30 mg/kg The spread of anaesthesia obtained with Bupivacaine injection depends on several factors including the volume of solution and the position of the patient during and following the injection.

When injected at the L3–L4 intervertebral space, with the patient in the sitting position, 3 ml of Bupivacaine injection spreads to the T7–T10 spinal segments. With the patient receiving the injection in the horizontal position and then turned supine, the blockade spreads to T4–T7 spinal segments.

It should be understood that the level of spinal anaesthesia achieved with any local anaesthetic can be unpredictable in a given patient. The recommended site of injection is below L3. The effects of injections of Bupivacaine injection exceeding 4 ml have not yet been studied and such volumes can therefore not be recommended.

Method of administration Route of administration:

For intrathecal injection. 1. Hypersensitivity to local anaesthetics of the amide type. Intrathecal anaesthesia, regardless of the local anaesthetic used, has its own contraindications, which include: • Active disease of the central nervous system such as meningitis, poliomyelitis, intracranial haemorrhage, sub-acute combined degeneration of the cord due to pernicious anaemia and cerebral and spinal tumours.

1. Hypersensitivity to local anaesthetics of the amide type. Intrathecal anaesthesia, regardless of the local anaesthetic used, has its own contraindications, which include: • Active disease of the central nervous system such as meningitis, poliomyelitis, intracranial haemorrhage, sub-acute combined degeneration of the cord due to pernicious anaemia and cerebral and spinal tumours.

g. g. fracture) in the vertebral column. • Septicaemia. • Pyogenic infection of the skin at or adjacent to the site of lumbar puncture. • Cardiogenic or hypovolaemic shock. • Coagulation disorders or ongoing anticoagulation treatment.