Pronunciation:

(byoo PIV a kane)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Lactation:

Contraindications:

Warnings/Precautions:

Adverse Reactions:

Cardiovascular: Hypotension, bradycardia, palpitation, heart block, ventricular arrhythmia, cardiac arrest

Central nervous system: Restlessness, anxiety, dizziness, seizure (0.1%); rare symptoms (usually associated with unintentional subarachnoid injection during high spinal anesthesia) include persistent anesthesia, paresthesia, paralysis, headache, septic meningitis, and cranial nerve palsies

Gastrointestinal: Nausea, vomiting; rare symptoms (usually associated with unintentional subarachnoid injection during high spinal anesthesia) include fecal incontinence and loss of sphincter control

Genitourinary: Rare symptoms (usually associated with unintentional subarachnoid injection during high spinal anesthesia) include urinary incontinence, loss of perineal sensation, and loss of sexual function

Neuromuscular & skeletal: Weakness

Ocular: Blurred vision, pupillary constriction

Otic: Tinnitus

Respiratory: Apnea, hypoventilation (usually associated with unintentional subarachnoid injection during high spinal anesthesia)

Miscellaneous; Allergic reactions (urticaria, pruritus, angioedema), anaphylactoid reactions

Overdosage/Toxicology:

Drug Interactions:

Increased effect: Hyaluronidase

Increased toxicity: Beta-blockers, ergot-type oxytocics, MAO inhibitors, TCAs, phenothiazines, vasopressors

Stability:

Compatibility:

Compatibility in syringe: Compatible: Clonidine with morphine, diamorphine, fentanyl with ketamine, hydromorphone, iohexol, morphine. Variable (consult detailed reference): Sodium bicarbonate

Compatibility when admixed: Compatible: Buprenorphine, diamorphine, epinephrine, fentanyl, hydromorphone, morphine, sufentanil

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: Anesthesia (route dependent): 4-10 minutes

Duration: 1.5-8.5 hours

Metabolism: Hepatic

Half-life elimination (age dependent): Neonates: 8.1 hours; Adults: 1.5-5.5 hours

Excretion: Urine (~6%)

Dosage:

Local anesthesia: Infiltration: 0.25% infiltrated locally; maximum: 175 mg

Caudal block (with or without epinephrine, preservative free):

Children: 1-3.7 mg/kg

Adults: 15-30 mL of 0.25% or 0.5%

Epidural block (other than caudal block - with or without epinephrine, preservative free):

Administer in 3-5 mL increments, allowing sufficient time to detect toxic manifestations of inadvertent I.V. or I.T. administration:

Children: 1.25 mg/kg/dose

Adults: 10-20 mL of 0.25% or 0.5%

Surgical procedures requiring a high degree of muscle relaxation and prolonged effects only: 10-20 mL of 0.75% (Note: Not to be used in obstetrical cases)

Maxillary and mandibular infiltration and nerve block: 9 mg (1.8 mL) of 0.5% (with epinephrine) per injection site; a second dose may be administered if necessary to produce adequate anesthesia after allowing up to 10 minutes for onset, up to a maximum of 90 mg per dental appointment

Obstetrical anesthesia: Incremental dose: 3-5 mL of 0.5% (not exceeding 50-100 mg in any dosing interval); allow sufficient time to detect toxic manifestations or inadvertent I.V. or I.T. injection

Peripheral nerve block: 5 mL of 0.25 or 0.5%; maximum: 400 mg/day

Sympathetic nerve block: 20-50 mL of 0.25%

Retrobulbar anesthesia: 2-4 mL of 0.75%

Spinal anesthesia: Solution of 0.75% bupivacaine in 8.25% dextrose is used:

Lower extremity and perineal procedures: 1 mL

Lower abdominal procedures: 1.6 mL

Obstetrical:

Normal vaginal delivery: 0.8 mL (higher doses may be required in some patients)

Cesarean section: 1-1.4 mL

Administration:

Monitoring Parameters:

Patient Education:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

Injection, solution, as hydrochloride [preservative free]: 0.25% [2.5 mg/mL] (10 mL, 20 mL, 30 mL, 50 mL); 0.5% [5 mg/mL] (10 mL, 20 mL, 30 mL); 0.75% [7.5 mg/mL] (10 mL, 20 mL, 30 mL)

Marcaine®: 0.25% [2.5 mg/mL] (10 mL, 30 mL, 50 mL); 0.5% [5 mg/mL] (10 mL, 30 mL); 0.75% [7.5 mg/mL] (10 mL, 30 mL)

Marcaine® Spinal: 0.75% [7.5 mg/mL] (2 mL) [in dextrose 8.25%]

Sensorcaine®-MPF: 0.25% [2.5 mg/mL] (10 mL, 30 mL); 0.5% [5 mg/mL] (10 mL, 30 mL); 0.75% [7.5 mg/mL] (10 mL, 30 mL)

Injection, solution, as hydrochloride (Marcaine®, Sensorcaine®): 0.25% [2.5 mg/mL] (50 mL); 0.5% [5 mg/mL] (50 mL) [contains methylparaben]

Injection, solution, with epinephrine 1:200,000, as hydrochloride [preservative free]: 0.25% [2.5 mg/mL] (10 mL, 30 mL); 0.5 % [5 mg/mL] (30 mL)

Marcaine®: 0.25% [2.5 mg/mL] (10 mL, 30 mL); 0.5% [5 mg/mL] (3 mL, 10 mL, 30 mL); 0.75% [7.5 mg/mL] (30 mL) [contains sodium metabisulfite]

Sensorcaine®-MPF: 0.25% [2.5 mg/mL] (10 mL, 30 mL); 0.5% [5 mg/mL] (10 mL, 30 mL); 0.75% [7.5 mg/mL] (30 mL) [contains sodium metabisulfite]

Injection, solution, with epinephrine 1:200,000, as hydrochloride [with preservative] (Marcaine®, Sensorcaine®): 0.25% [2.5 mg/mL] (50 mL); 0.5% [5 mg/mL] (50 mL) [contains methylparaben and sodium metabisulfite]

International Brand Names: