Bupivacaine Hydrochloride + Dextrose: Brands, Price & Uses in Bangladesh

Bupivacaine Hydrochloride + Dextrose is a hyperbaric ("heavy") local anesthetic solution indicated for producing subarachnoid block (spinal anesthesia) in adults undergoing surgical procedures. The dextrose component increases the specific gravity of the solution above that of cerebrospinal fluid, allowing the anesthesia provider to control the spread of the block within the subarachnoid space by positioning the patient.

• Established/FDA-approved use: Spinal (subarachnoid) anesthesia for lower extremity and perineal surgical procedures, lower abdominal surgical procedures, and vaginal delivery.
• Established/FDA-approved use: Spinal anesthesia for cesarean section, when administered by personnel experienced in obstetric anesthesia.

Bupivacaine Hydrochloride + Dextrose is intended for use only by, or under the direct supervision of, clinicians experienced in the techniques of spinal anesthesia, with resuscitation equipment and drugs immediately available.

Bupivacaine Hydrochloride + Dextrose is for subarachnoid (spinal/intrathecal) injection ONLY, to be administered by or under the direct supervision of clinicians experienced in spinal anesthesia, in a setting equipped with full resuscitation and continuous cardiovascular/respiratory monitoring. Dose depends on the procedure, desired block height, and patient factors, and must be individualized by the treating anesthesiologist.

The syringe must always be aspirated before and during injection to check for blood or cerebrospinal fluid. Vital signs (blood pressure, heart rate, oxygen saturation, respiratory rate) must be monitored continuously during and after administration of Bupivacaine Hydrochloride + Dextrose because of the risk of high spinal block, severe hypotension, and cardiorespiratory compromise. Dose reduction and careful titration are recommended in elderly, pregnant, and debilitated patients. Do not use if the solution is discolored, cloudy, or contains particulate matter; discard any unused portion as this is a single-dose, preservative-free product.

Adverse effects of Bupivacaine Hydrochloride + Dextrose are largely related to the physiological effects of spinal anesthesia (sympathetic blockade) and, rarely, to systemic absorption or inadvertent intravascular exposure.

• Very common: Hypotension (due to sympathetic nerve blockade), bradycardia.
• Common: Nausea and vomiting (usually secondary to hypotension), urinary retention, post-dural puncture (spinal) headache, backache at the injection site, shivering.
• Less common/serious: High or total spinal block with respiratory insufficiency or apnea, diaphragmatic paralysis, severe/prolonged hypotension, cardiac arrhythmias including bradyarrhythmias progressing to cardiac arrest.
• Rare but serious: Local anesthetic systemic toxicity (LAST) presenting as circumoral numbness, tinnitus, dizziness, tremors, seizures, and cardiovascular collapse, typically from inadvertent intravascular injection; allergic/anaphylactic reactions; neurological complications such as persistent paresthesia, arachnoiditis, or cauda equina syndrome (very rare); methemoglobinemia.