Drugs List

Therapeutic Indications

Uses

Spinal anaesthesia for abdominal surgery lasting 45-60 minutes
Spinal anaesthesia for lower abdominal surgery lasting 1.5-3 hours
Spinal anaesthesia for urological and limb surgery lasting 2 - 3 hours
Spinal anaesthesia for urological and lower limbs surgery lasting 1.5-3 hrs

Administration

For intrathecal injection only.

The recommended site of injection is below L3 intervertebral space.

When injected at L3 to L4, while the patient is sitting, 3ml of bupivacaine hydrochloride spreads to the T7 to T10 spinal segments.
When injected while the patient is in a horizontal position and then turned supine, the blockade spreads to T4 to T7 spinal segments.

If the anaesthesia appears inadequate, changing the position of the patient within twenty minutes of administration may improve distribution of the local anaesthetic agent within the subarachnoid space.

If the anaesthesia fails, a new attempt can be made to administer the anaesthetic agent at a different level of the spinal cord, using a smaller volume of the drug.

Contraindications

Administration site infection
Hypovolaemic shock
Inflammation of injection site
Meningitis
Septicaemia
Spinal stenosis
Spondylitis
Cardiogenic shock
Central nervous system disorder
Central nervous system neoplasm
Coagulopathy
Intracranial haemorrhage
Poliomyelitis
Spinal cord injury
Subacute combined degeneration of spinal cord due to B12 deficiency
Tuberculosis of spine

Precautions and Warnings

Debilitation
Elderly
Cardiac conduction defects
Cardiovascular disorder
Epileptic disorder
Hemiplegia
Hypertension
Hypovolaemia
Multiple sclerosis
Myasthenia gravis
Neuromuscular disorder
Paraplegia
Pleural effusion
Pregnancy
Respiratory impairment
Severe hepatic impairment
Severe myocardial depression
Severe renal impairment

Septicaemia increases risk of post-op intraspinal abscess formation
Advise ability to drive/operate machinery may be affected by side effects
Not all available brands are licensed for all indications
Treatment to be initiated and supervised by a specialist
Do not inject near site of skin infection
Resuscitation facilities must be immediately available
Monitor vital signs, respiration & cardiac function
Discontinue if signs of acute systemic toxicity or total spinal block occur
Maintain treatment at the lowest effective dose
Reduce dose in debilitated patients
Reduce dose in elderly
Reduce dose when given in late stages of pregnancy

Intrathecal anaesthesia can lead to hypotension and bradycardia. Precautions against these effects should be taken and may include pre-loading the circulation with crystalloid or colloid solution. If hypotension occurs, it should be treated appropriately. Marked hypotension should be avoided in patients with cardiac decompensation.

Intravenous access should be in place before commencing with intrathecal anaesthesia.

Intrathecal anaesthesia can cause intercostal paralysis and patients with pleural effusions may suffer respiratory embarrassment.

Pregnancy and Lactation

Pregnancy

Use bupivacaine and glucose with caution during pregnancy.

The manufacturer advises caution if bupivacaine and glucose is used during pregnancy. Available reports indicate no increased risk of teratogenic or developmental effects. However, in patients who are in the late stages of pregnancy, the manufacturer advises that dose should be reduced due to the risk of neonatal respiratory depression, hypotension and bradycardia.

Lactation

Bupivacaine and glucose is considered safe for use during breastfeeding.

The manufacturer states bupivacaine and glucose may be used safely when breastfeeding. Bupivacaine is present in human breast milk, but the quantities are so small and it is not orally absorbed, that there is generally no risk to the child at therapeutic doses. Cases of breastfed infants exposed to bupivacaine have shown no adverse effects.

Side Effects

Abscess formation (injection site)
Allergic reaction
Anaphylactic shock
Arachnoiditis
Back pain
Bradycardia
Cardiac arrest
Convulsions
Dysaesthesia
Hypotension
Muscle weakness
Nausea
Neuropathy
Paraesthesia
Paralysis
Paraplegia
Paresis
Postdural puncture headache
Respiratory depression
Urinary incontinence
Urinary retention
Vomiting

Presentation

Injection containing bupivacaine hydrochloride in hypertonic glucose solution.

Drugs List

Therapeutic Indications

Uses

Spinal anaesthesia for abdominal surgery lasting 45-60 minutes
Spinal anaesthesia for lower abdominal surgery lasting 1.5-3 hours
Spinal anaesthesia for urological and limb surgery lasting 2 - 3 hours
Spinal anaesthesia for urological and lower limbs surgery lasting 1.5-3 hrs

Dosage

When using this agent, specialist literature, national guidelines and Trust policies should be consulted to ensure appropriate dosage and assessment of patient factors.

Adults

Children

Additional Dosage Information

Administration

For intrathecal injection only.

The recommended site of injection is below L3 intervertebral space.

When injected at L3 to L4, while the patient is sitting, 3ml of bupivacaine hydrochloride spreads to the T7 to T10 spinal segments.
When injected while the patient is in a horizontal position and then turned supine, the blockade spreads to T4 to T7 spinal segments.

If the anaesthesia appears inadequate, changing the position of the patient within twenty minutes of administration may improve distribution of the local anaesthetic agent within the subarachnoid space.

If the anaesthesia fails, a new attempt can be made to administer the anaesthetic agent at a different level of the spinal cord, using a smaller volume of the drug.

Contraindications

Administration site infection
Hypovolaemic shock
Inflammation of injection site
Meningitis
Septicaemia
Spinal stenosis
Spondylitis
Cardiogenic shock
Central nervous system disorder
Central nervous system neoplasm
Coagulopathy
Intracranial haemorrhage
Poliomyelitis
Spinal cord injury
Subacute combined degeneration of spinal cord due to B12 deficiency
Tuberculosis of spine

Precautions and Warnings

Debilitation
Elderly
Cardiac conduction defects
Cardiovascular disorder
Epileptic disorder
Hemiplegia
Hypertension
Hypovolaemia
Multiple sclerosis
Myasthenia gravis
Neuromuscular disorder
Paraplegia
Pleural effusion
Pregnancy
Respiratory impairment
Severe hepatic impairment
Severe myocardial depression
Severe renal impairment

Septicaemia increases risk of post-op intraspinal abscess formation
Advise ability to drive/operate machinery may be affected by side effects
Not all available brands are licensed for all indications
Treatment to be initiated and supervised by a specialist
Do not inject near site of skin infection
Resuscitation facilities must be immediately available
Monitor vital signs, respiration & cardiac function
Discontinue if signs of acute systemic toxicity or total spinal block occur
Maintain treatment at the lowest effective dose
Reduce dose in debilitated patients
Reduce dose in elderly
Reduce dose when given in late stages of pregnancy

Intrathecal anaesthesia can lead to hypotension and bradycardia. Precautions against these effects should be taken and may include pre-loading the circulation with crystalloid or colloid solution. If hypotension occurs, it should be treated appropriately. Marked hypotension should be avoided in patients with cardiac decompensation.

Intravenous access should be in place before commencing with intrathecal anaesthesia.

Intrathecal anaesthesia can cause intercostal paralysis and patients with pleural effusions may suffer respiratory embarrassment.

Pregnancy and Lactation

Pregnancy

Use bupivacaine and glucose with caution during pregnancy.

The manufacturer advises caution if bupivacaine and glucose is used during pregnancy. Available reports indicate no increased risk of teratogenic or developmental effects. However, in patients who are in the late stages of pregnancy, the manufacturer advises that dose should be reduced due to the risk of neonatal respiratory depression, hypotension and bradycardia.

Lactation

Bupivacaine and glucose is considered safe for use during breastfeeding.

The manufacturer states bupivacaine and glucose may be used safely when breastfeeding. Bupivacaine is present in human breast milk, but the quantities are so small and it is not orally absorbed, that there is generally no risk to the child at therapeutic doses. Cases of breastfed infants exposed to bupivacaine have shown no adverse effects.

Side Effects

Abscess formation (injection site)
Allergic reaction
Anaphylactic shock
Arachnoiditis
Back pain
Bradycardia
Cardiac arrest
Convulsions
Dysaesthesia
Hypotension
Muscle weakness
Nausea
Neuropathy
Paraesthesia
Paralysis
Paraplegia
Paresis
Postdural puncture headache
Respiratory depression
Urinary incontinence
Urinary retention
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: August 2013

Reference Sources

Summary of Product Characteristics: Marcain Heavy, 0.5% solution for injection. AstraZeneca UK Ltd. Revised March 2013.

Summary of Product Characteristics: Bupivacaine Heavy 5 mg/ml Solution for Injection. Panpharma UK Ltd. Revised April 2019.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 06 October 2022