adrenaline acid tartrate + bupivacaine hydrochloride: clinical use

Prescribing considerations

• Use only in an appropriately staffed and equipped setting with monitoring and resuscitation facilities immediately available.
• Minimise intravascular injection through careful technique and aspiration; stop administration if toxicity develops.
• Use particular caution for major blocks and in older or debilitated people, people with conduction disease, advanced liver disease, severe renal dysfunction or late pregnancy.
• Safety and efficacy are not established for children younger than 1 year.

Contraindications and cautions

• Hypersensitivity to bupivacaine, adrenaline, an excipient or another amide local anaesthetic.
• Intravenous regional anaesthesia.
• Thyrotoxicosis or severe heart disease, particularly with tachycardia.
• Injection into end-artery or compromised-circulation sites.
• For epidural techniques: relevant central nervous system disease, infection near the puncture site, spinal tuberculosis, cardiogenic or hypovolaemic shock, coagulation disorders or ongoing anticoagulant therapy.

Monitoring

• Observe for early central nervous system toxicity.
• Monitor heart rate, blood pressure, rhythm and respiratory function during major or epidural blocks.
• Anticipate hypotension and bradycardia with epidural anaesthesia.
• Consider glucose and potassium effects in susceptible patients or when interacting medicines are present.

Clinical pharmacology

Bupivacaine is a long-acting amide local anaesthetic that inhibits nerve-impulse conduction. Adrenaline produces local vasoconstriction, prolonging local action but adding sympathomimetic cardiovascular and metabolic effects.

Formulation and product differences

• The selected product is a colourless or almost colourless aqueous solution for injection in single-use glass ampoules.
• It contains sodium metabisulfite, which can rarely cause severe hypersensitivity reactions or bronchospasm, and also contains sodium.
• Do not mix with other medicines; discard solution remaining after an ampoule is opened.
• The solution should not be stored in contact with metal syringe or needle components.