bupivacaine hydrochloride anhydrous: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
bupivacaine hydrochloride anhydrous: clinical details
Prescribing considerations
- Intrathecal administration should be undertaken only by clinicians experienced in spinal anaesthesia, with intravenous access and resuscitation resources immediately available.
- Assess cardiovascular status, circulating volume, neurological disease, hepatic or renal dysfunction and factors increasing the risk of extensive spinal block.
- Patient position and the hyperbaric formulation affect initial intrathecal spread.
Contraindications and cautions
- Hypersensitivity to bupivacaine, an excipient or amide local anaesthetics
- Acute active cerebrospinal disease, relevant spinal pathology or recent vertebral trauma
- Septicaemia or pyogenic infection at or near the puncture site
- Cardiogenic or hypovolaemic shock
- Coagulation disorders or ongoing anticoagulant treatment
- Pernicious anaemia with subacute combined degeneration of the spinal cord
Monitoring
- Continuously assess blood pressure, heart rate, ventilation, oxygenation, consciousness and block extent.
- Watch for early neurological or cardiovascular features of local-anaesthetic systemic toxicity and for high or total spinal block.
- Consider ECG monitoring when cardiac disease or interacting antiarrhythmic treatment increases risk.
- Confirm recovery of motor, sensory and bladder function before discharge.
Clinical pharmacology
Bupivacaine is a long-acting amide local anaesthetic that reversibly inhibits sodium-ion transport through nerve membranes. The hyperbaric glucose-containing solution has gravity-dependent initial spread. Bupivacaine is highly protein-bound, extensively metabolised in the liver and crosses the placenta; only small quantities enter breast milk.
Formulation and product differences
- The selected formulation is a clear, colourless, glucose-containing hyperbaric solution intended only for intrathecal use.
- It is supplied in single-use glass ampoules and should be used immediately after opening; remaining solution must be discarded.
- It is essentially sodium-free. Other bupivacaine formulations may have different routes, excipients and licensed indications and are not interchangeable without checking the product information.
bupivacaine hydrochloride anhydrous preparations and strengths
Injection
Route: Parenteral
Strengths: 5 mg/mL, 0.5% w/v
bupivacaine hydrochloride anhydrous interactions
The anaesthetic team should review all prescribed, non-prescribed and recently used medicines.
Other local anaesthetics or related amide antiarrhythmics, including lidocaine, mexiletine and tocainide
Toxic effects on the nervous system and heart may be additive.
Class III antiarrhythmics, including amiodarone
Cardiac effects may be additive, so close surveillance and ECG monitoring may be considered.
Cimetidine
May reduce bupivacaine clearance and increase exposure.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.