Bupivacaine (PF) (bupivacaine HCl/PF)

Dosage of bupivacaine varies with the anesthetic procedure, degree of anesthesia required, surgical site, and individual patient response. The usual dosages should generally be reduced in geriatric, debilitated, or acutely ill patients and in patients with cardiac and/or hepatic disease. The lowest effective dose should be used.

Conventional bupivacaine hydrochloride preparations may be administered by local infiltration or by lumbar epidural (including caudal), peripheral, retrobulbar, sympathetic, or dental block. For spinal anesthesia, 0.75% bupivacaine hydrochloride in 8.25% dextrose is administered by subarachnoid injection. BUPivacaine liposomal injection (Exparel(R)) is administered by local infiltration or interscalene brachial plexus nerve block; the liposomal formulation should not be administered by epidural or intrathecal routes, and should not be used for other regional nerve blocks.

Local anesthetics, including bupivacaine, have been administered by continuous intra-articular infusion+ (e.g., for control of postoperative pain); however, such use has been associated with chondrolysis. (See Cautions: Musculoskeletal Effects in the Local Anesthetics, Parenteral, General Statement 72:00.) BUPivacaine should not be administered using the Bier block technique (IV regional anesthesia) due to the risk of cardiac arrest and death.

BUPivacaine solutions containing preservatives should not be used for epidural or caudal block. Partially used solutions that do not contain preservatives should be discarded.

The liposomal formulation is not bioequivalent to and should not be used interchangeably with other bupivacaine formulations.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

There is no enhanced messaging for this drug.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

BUPivacaine shares the toxic potentials of the local anesthetics, and the usual precautions of local anesthetic therapy should be observed. (See Cautions in the Local Anesthetics, Parenteral, General Statement 72:00.)

Adverse effects of bupivacaine generally are limited when administered locally at the recommended dosages and routes. However, excessive plasma concentrations can lead to systemic toxicity manifesting principally as CNS and cardiovascular effects.

The 0.75% solution of bupivacaine hydrochloride is not recommended for obstetric anesthesia since use of this concentration for epidural anesthesia in obstetric patients has been associated with cardiac arrest with difficult resuscitation or death. Cardiac arrest has occurred after seizures resulting from systemic toxicity, apparently following inadvertent intravascular injection.

Some commercially available formulations of bupivacaine hydrochloride contain sodium metabisulfite, a sulfite that may cause allergic-type reactions, including anaphylaxis and life-threatening or less severe asthmatic episodes, in certain susceptible individuals. The overall prevalence of sulfite sensitivity in the general population is unknown but probably low; such sensitivity appears to occur more frequently in asthmatic than in nonasthmatic individuals.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.