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Bupivacaine Hydrochloride: Brands, Price & Uses in Bangladesh
Bupivacaine Hydrochloride is a long-acting amide-type local anesthetic indicated for the production of local or regional anesthesia and analgesia in adults and, in specific clinical circumstances and more.
About Bupivacaine Hydrochloride
Indications of Bupivacaine Hydrochloride
Bupivacaine Hydrochloride is a long-acting amide-type local anesthetic indicated for the production of local or regional anesthesia and analgesia in adults and, in specific clinical circumstances, older pediatric patients. Established, FDA-approved uses include:
- Local infiltration anesthesia for minor surgical procedures.
- Peripheral nerve blocks (e.g., brachial plexus, intercostal, pudendal) for surgical and postoperative analgesia.
- Sympathetic nerve blocks for pain management.
- Epidural anesthesia (lumbar and caudal), including for surgical procedures and obstetric labor analgesia, at appropriate concentrations.
- Retrobulbar block for ophthalmic surgery.
- Dental anesthesia (typically as a formulation combined with epinephrine).
Bupivacaine Hydrochloride is not recommended for intravenous regional anesthesia (Bier block) or obstetric paracervical block, and the 0.75% concentration must never be used for obstetric epidural anesthesia (see Contraindications). It is also used off-label, based on clinical experience, for continuous wound infiltration and intra-articular administration for postoperative pain, although intra-articular infusion is not an approved use and carries a specific risk (see Precautions and Warnings).
Dosage & Administration of Bupivacaine Hydrochloride
Dosage of Bupivacaine Hydrochloride depends on the procedure, the site and route of administration, the vascularity of the tissue, individual patient tolerance, and the concentration/volume used. The lowest concentration and dose producing the desired effect should always be used, and the maximum recommended single dose should not be exceeded.
| Indication | Typical Concentration | Approximate Adult Dose |
|---|---|---|
| Local infiltration | 0.25% | Up to 175 mg (up to 70 mL of 0.25%) per single dose |
| Peripheral nerve block | 0.25%–0.5% | Individualized; typically 12.5–150 mg depending on nerve(s) blocked |
| Lumbar epidural (surgical) | 0.5%–0.75% | 25–150 mg per injection, incremental dosing |
| Lumbar epidural (obstetric labor) | 0.25%–0.5% only (0.75% contraindicated) | Individualized; incremental low-dose administration |
| Caudal block | 0.25%–0.5% | 37.5–150 mg |
| Retrobulbar block | 0.75% | 15–30 mg (2–4 mL) |
The maximum total dose in adults should generally not exceed 400 mg in a 24-hour period, and repeat doses should not be given more frequently than every 3 hours, adjusted for patient factors and clinical response. Bupivacaine Hydrochloride must be administered only by, or under the supervision of, clinicians experienced in regional anesthesia, with resuscitation equipment and drugs (including lipid emulsion for local anesthetic systemic toxicity) immediately available. Careful aspiration before and during injection is essential to avoid inadvertent intravascular injection, and incremental (fractionated) dosing is recommended for epidural and other major nerve blocks.
Side Effects of Bupivacaine Hydrochloride
Most adverse effects of Bupivacaine Hydrochloride are dose-related and result from high plasma concentrations due to rapid absorption, inadvertent intravascular injection, or metabolic slowing.
- Common/expected effects of the anesthetic block itself: hypotension, bradycardia, transient numbness, and, with neuraxial blocks, urinary retention.
- Central nervous system: lightheadedness, restlessness, anxiety, tinnitus, blurred vision, tremor, and, at higher levels, seizures, drowsiness, or unconsciousness.
- Cardiovascular: hypotension, bradycardia, arrhythmias, myocardial depression, and, rarely, cardiac arrest (which can be particularly resistant to resuscitation with Bupivacaine Hydrochloride).
- Hypersensitivity reactions: urticaria, pruritus, angioedema, and rarely anaphylaxis.
- Other: nausea and vomiting, backache (with neuraxial techniques), and methemoglobinemia (uncommon, but a recognized risk).
Contraindications of Bupivacaine Hydrochloride
Bupivacaine Hydrochloride is contraindicated in the following situations:
- Known hypersensitivity to Bupivacaine Hydrochloride, to other amide-type local anesthetics, or to any component of the formulation.
- Obstetric paracervical block anesthesia (associated with fetal bradycardia and death).
- Intravenous regional anesthesia (Bier block), due to risk of severe cardiovascular toxicity upon tourniquet release.
- The 0.75% concentration is specifically contraindicated for obstetric epidural anesthesia because of an increased risk of cardiac arrest with difficult resuscitation, or death, if inadvertent intravascular injection occurs.
Frequently Asked Questions about Bupivacaine Hydrochloride
What is Bupivacaine Hydrochloride used for?
Bupivacaine Hydrochloride is a long-acting local anesthetic used to numb specific areas of the body for surgery, labor, and pain management, including local infiltration, nerve blocks, and epidural/spinal anesthesia.
Is Bupivacaine Hydrochloride safe during pregnancy?
Bupivacaine Hydrochloride should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus, and only under close medical supervision. It is contraindicated for obstetric paracervical block, and the 0.75% concentration must never be used for obstetric epidural anesthesia due to a risk of serious cardiac events with accidental intravascular injection. Always consult your physician.
Can Bupivacaine Hydrochloride be used in children?
The safety and efficacy of Bupivacaine Hydrochloride in children under 12 years have not been well established for most uses, so it is generally avoided in this age group except in specialized pediatric anesthesia settings with careful weight-based dosing.
What are the serious risks of Bupivacaine Hydrochloride?
The most serious risk is accidental injection of Bupivacaine Hydrochloride into a blood vessel, which can cause severe central nervous system effects (such as seizures) and cardiovascular effects (such as dangerous heart rhythm problems or cardiac arrest) that can be difficult to resuscitate. It should only be given by trained professionals with resuscitation equipment on hand.
What should I do if I think there has been an overdose of Bupivacaine Hydrochloride?
An overdose or toxic reaction to Bupivacaine Hydrochloride is a medical emergency. Seek immediate medical attention or contact emergency services/poison control right away; do not try to manage it at home.
How is Bupivacaine Hydrochloride given?
Bupivacaine Hydrochloride is given only by injection, by or under the supervision of a trained clinician, using techniques such as local infiltration, nerve block, or epidural/spinal injection. It is never taken by mouth.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.