Drug Guide
Bupivacaine Hydrochloride; Epinephrine Bitartrate
Classification
Therapeutic: Local anesthetic, vasoconstrictor combination
Pharmacological: Amide local anesthetic with adrenergic agent (epinephrine)
FDA Approved Indications
- Regional anesthesia for surgeries and procedures
- Epidural analgesia for pain management
Mechanism of Action
Bupivacaine blocks sodium channels, inhibiting nerve impulse initiation and conduction; epinephrine causes vasoconstriction, prolonging the anesthetic effect and reducing systemic absorption.
Dosage and Administration
Adult: Dosage varies by procedure; typically, 15-175 mg for infiltration and 10-150 mg for epidural. Use the lowest effective dose.
Pediatric: Dosing based on weight and age; consult specific guidelines.
Geriatric: Start with lower doses due to increased sensitivity and comorbidities.
Renal Impairment: Adjust dosage as necessary; careful monitoring recommended.
Hepatic Impairment: Use with caution; metabolism occurs primarily in the liver.
Pharmacokinetics
Absorption: Absorbed locally with systemic absorption depending on site and dose.
Distribution: Wide distribution; highly protein-bound.
Metabolism: Primarily in the liver via amidases.
Excretion: Renally excreted as metabolites.
Half Life: Approx. 2.7 hours in healthy adults.
Contraindications
- Hypersensitivity to amide anesthetics or sympathomimetics.
- Severe hepatic impairment.
- Allergy to sulfites (if preserved with sulfites).
Precautions
- Use with caution in patients with cardiovascular disease, myasthenia gravis, or conduction abnormalities. Monitor cardiovascular and neurological status during administration.
Adverse Reactions - Common
- CNS toxicity (e.g., tinnitus, dizziness, seizures) (Uncommon at recommended doses.)
- Cardiovascular effects (e.g., hypotension, arrhythmias) (Uncommon.)
Adverse Reactions - Serious
- Cardiac arrest, severe CNS toxicity, allergic reactions (Rare.)
Drug-Drug Interactions
- Additive effects with other CNS depressants or other local anesthetics.
Drug-Food Interactions
- None significant.
Drug-Herb Interactions
- Potential interactions with herbal products affecting coagulation or cardiovascular system.
Nursing Implications
Assessment: Monitor vital signs, neurological status, and for signs of toxicity.
Diagnoses:
- Risk for arrhythmias
- Risk for toxicity from local anesthetics
Implementation: Administer slowly, observe patient, and have resuscitative equipment available.
Evaluation: Assess for adequate anesthesia and watch for adverse reactions.
Patient/Family Teaching
- Inform about potential side effects.
- Advise to report symptoms of toxicity (e.g., numbness, dizziness, irregular heartbeat).
- Ensure understanding of the purpose of epinephrine in prolonging anesthetic effect.
Special Considerations
Black Box Warnings:
- Potential for cardiotoxicity and neurological injury if used improperly.
Genetic Factors: Genetic variations in hepatic enzymes may affect metabolism.
Lab Test Interference: None noted.
Overdose Management
Signs/Symptoms: Central nervous system excitation followed by depression, cardiac depression, arrhythmias, seizures.
Treatment: Supportive care, airway management, benzodiazepines for seizures, lipid emulsion therapy for cardiotoxicity.
Storage and Handling
Storage: Store at room temperature, protected from light.
Stability: Stable until expiration date when properly stored.