bupivacaine + fentanyl citrate: clinical use

Prescribing considerations

• Epidural administration only, by or under clinicians experienced in regional anaesthesia; resuscitation equipment, oxygen and opioid reversal treatment must be immediately available.
• Review medicines, coagulation status, respiratory reserve, cardiovascular and neurological disease, opioid-use risk and previous opioid or local-anaesthetic exposure.
• Consider accumulation in hepatic or renal impairment and greater sensitivity in older or debilitated patients.
• The product contains a clinically relevant sodium load.

Contraindications and cautions

• Hypersensitivity to either active ingredient or an excipient
• Acute respiratory depression, acute alcoholism, raised intracranial pressure or significant head injury
• Hypovolaemia, complete heart block or cardiogenic shock
• Concurrent or recent monoamine oxidase inhibitor treatment
• Coagulation disorder or ongoing anticoagulant therapy
• Infection near the puncture site and specified serious central nervous system, spinal or intracranial disorders
• Intravenous regional anaesthesia and obstetric paracervical block

Monitoring

• Airway, respiratory rate, oxygenation, sedation and verbal responsiveness
• Blood pressure, pulse and cardiovascular stability
• Pain relief, sensory-block level and motor block
• Neurological symptoms and early systemic local-anaesthetic toxicity
• Maternal cardiovascular status and fetal heart rate during labour
• Urinary retention and catheter function where relevant
• Opioid misuse, tolerance, dependence or withdrawal with repeated exposure

Clinical pharmacology

Bupivacaine is a long-acting amide local anaesthetic that blocks voltage-dependent sodium-channel conduction. Epidural fentanyl provides opioid-receptor analgesia and enhances bupivacaine’s regional effect. Both undergo hepatic metabolism and are mainly eliminated through the kidneys.

Formulation and product differences

• Clear, colourless, sterile premixed solution in single-use polypropylene infusion bags.
• For continuous epidural infusion; not for bolus or intravenous administration.
• Compatibility with other medicines has not been established, so it should not be mixed with them.
• Use immediately after opening. Discard discoloured solution, unused portions and partly used bags; do not reconnect them.