Drug belonging to the group of local anesthetics indicated for infiltration. Central regional anesthesia for blockage. Palliative of Pain caused by Cancer .
Composition
Each milliliter contains 5 milligrams of bupivacaine hydrochloride.
Indications
- Local anesthetic (for infiltration).
- Central regional anesthesia for caudal, epidural or some peripheral nerve block (spinal, maxillary, mandibular, ophthalmic anesthesia, etc.).
- In obstetrics.
- Palliative of Pain caused by Cancer .
- Preventing the Pain Postoperative .
- Sympathetic block.
Contraindications
Hypersensitivity to local anesthetics of the amide group.
History of malignant hypertension . Paracervical anesthesia in labor (can cause bradycardia and fetal death). Intravenous regional anesthesia
Precautions
E: risk category: C. Labor: 0.75% bupivacaine should not be used; its epidural, subarachnoid or pudendal administration can produce changes in uterine contractility and maternal hypotension , in addition to fetal or neonatal toxicity . LM: No data available. Child: insufficient safety studies in children under 12 years of age. Older adult: increased risk of toxicity. Kidney deficiency: accumulation of metabolites and increased toxicity. Hepatic impairment: requires dose adjustment. For epidural or spinal block (do not use preservative preparations): heart block, severe bleeding, hypotension , shock; sepsis, history of hyperthermia malignant, inflammation or infection at the puncture site; spinal deformations; bleeding disorders, headache, or a history of migraine.
Adverse reactions
Related to excessive dose or inadvertent intravascular administration. Occasional: Hypotension , Cardiovascular Depression , Arrhythmias , Peripheral Vasodilation, Heart Block, Excited by CNS Depression , Anxiety, Dizziness , Tinnitus, Blurred Vision, Tremors and Seizures; allergic reactions, Anaphylaxis . With epidural anesthesia: paralysis of the legs, bradycardia , retention or urinary and fecal incontinence; Low back pain , cranial nerve palsy, loss of consciousness, headache; sexual dysfunction, persistent anesthesia, septic meningitis.
Interactions
Antimiasténicos: the inhibition of the neuronal transmission induced by the local anesthetics can antagonize the antimiasténicos effects on the skeletal muscle. CNS depressants: may cause additive depressant effects. Disinfectant solutions (containing heavy metals): Local anesthetics can cause the release of heavy metal ions from these solutions, which, if sprayed with the anesthetic , can cause severe local irritation, swelling and edema . Guanethidine, Mecamylamine , Trimetaphan : the risk of severe hypotension and o Bradycardiait can be increased if high levels of spinal or epidural anesthesia are induced. MAOI: concomitant use in patients receiving local anesthetics for subarachnoid block may increase the risk of hypotension . Neuromuscular Blocking Agents : can intensify or prolong the action of neuromuscular Blockers . Opioid Analgesic Medications ( Narcotics ): may add to the alterations induced by opioid analgesics in respiratory rate and alveolar ventilation . Vasoconstrictors ( Epinephrine, methoxamine or phenylephrine): should be used with caution and in carefully selected amounts, if applicable, when anesthetizing with local anesthetics areas with terminal arteries (fingers and toes, penis) or with any other blood supply committed; Ischemia with Gangrene may occur .
Posology
Central regional anesthesia: epidural: partial to moderate motor block, 3-5 milliliters (25-50 milligrams); moderate to complete motor block 50-100 milligrams; complete motor block, 75-100 milligrams. Flow rate: moderate motor block 37.5-75 milligrams; complete motor block, 15-20 milliliters (75-150 milligrams). Peripheral nerve block: 5mL (25-175 milligrams). Sympathetic block: 50 –125 milligrams. Infiltration: up to 175 milligrams. Dosing can be repeated every 3 hours, as needed.
Treatment of overdose and serious adverse effects
General measures.
Basic information to the patient
Nothing to point out.