l CAUTIONS Arrhythmias . arteriosclerosis . cardiovascular

disease . cerebrovascular disease . cor pulmonale . debilitated patients (consider dose reduction). diabetes

mellitus . elderly (consider dose reduction). epilepsy . hypercalcaemia . hyperreflexia . hypertension . hyperthyroidism . hypokalaemia . hypovolaemia . impaired

cardiac conduction . impaired respiratory function . ischaemic heart disease . myasthenia gravis . obstructive

cardiomyopathy . occlusive vascular disease . organic brain

damage . phaeochromocytoma . prostate disorders . psychoneurosis . severe angina . shock . susceptibility to

angle-closure glaucoma

CAUTIONS, FURTHER INFORMATION

▶ Use of vasoconstrictors In patients with severe hypertension

or unstable cardiac rhythm, the use of adrenaline with a

local anaesthetic may be hazardous. For these patients an

anaesthetic without adrenaline should be used.

l INTERACTIONS → Appendix 1: articaine . sympathomimetics, vasoconstrictor

l SIDE-EFFECTS Face oedema . gingivitis . headache . nausea . sensation abnormal

SIDE-EFFECTS, FURTHER INFORMATION Toxic effects after

administration of local anaesthetics are a result of

excessively high plasma concentrations; severe toxicity

usually results from inadvertent intravascular injection.

The toxicity mainly involves the central nervous and

cardiovascular systems. The onset of toxicity can be

unpredictable and delayed. Monitor as per local protocol

for at least 30 minutes after administration.

l ALLERGY AND CROSS-SENSITIVITY

▶ Hypersensitivity and cross-sensitivity Hypersensitivity

reactions occur mainly with the ester-type local

anaesthetics, such as tetracaine; reactions are less

frequent with the amide types, such as articaine,

bupivacaine, levobupivacaine, lidocaine, mepivacaine,

prilocaine, and ropivacaine. Cross-sensitivity reactions

may be avoided by using the alternative chemical type.

l PREGNANCY Use only if potential benefit outweighs risk—

no information available.

l BREAST FEEDING Avoid breast-feeding for 48 hours after

administration.

l HEPATIC IMPAIRMENT Manufacturer advises caution

(increased risk of toxicity in severe impairment).

l RENAL IMPAIRMENT Manufacturers advise use with

caution in severe impairment.

l MONITORING REQUIREMENTS Consider monitoring blood

pressure and ECG (advised with systemic

adrenaline/epinephrine).

l MEDICINAL FORMS There can be variation in the licensing of

different medicines containing the same drug.

Solution for injection

EXCIPIENTS: May contain Sulfites

▶ Septanest (Septodont Ltd)

Adrenaline (as Adrenaline acid tartrate) 10 microgram per 1 ml,

Articaine hydrochloride 40 mg per 1 ml Septanest 1 in 100,000

solution for injection cartridges | 50 cartridge P £24.95

Adrenaline (as Adrenaline acid tartrate) 5 microgram per 1 ml,

Articaine hydrochloride 40 mg per 1 ml Septanest 1 in 200,000

solution for injection cartridges | 50 cartridge P £24.95

Bupivacaine hydrochloride 13-Jun-2018

l INDICATIONS AND DOSE

Surgical anaesthesia, lumbar epidural block

▶ BY REGIONAL ADMINISTRATION

▶ Adult: 75–150 mg, dose administered using a 5 mg/mL

(0.5%) solution

Surgical anaesthesia, field block

▶ BY REGIONAL ADMINISTRATION

▶ Adult: Up to 150 mg, dose administered using a

2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution

Surgical anaesthesia, thoracic epidural block

▶ BY THORACIC EPIDURAL

▶ Adult: 12.5–50 mg, dose administered using a

2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution

Surgical anaesthesia, caudal epidural block

▶ BY REGIONAL ADMINISTRATION

▶ Adult: 50–150 mg, dose administered using a

2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution

Surgical anaesthesia, major nerve block

▶ BY REGIONAL ADMINISTRATION

▶ Adult: 50–175 mg, dose administered using 5 mg/mL

(0.5%) solution

Acute pain, intra-articular block

▶ BY INTRA-ARTICULAR INJECTION

▶ Adult: Up to 100 mg, dose administered using a

2.5 mg/mL (0.25%) solution; when co-administered

with bupivacaine by another route, total max. 150 mg

Acute pain, thoracic epidural block

▶ BY CONTINUOUS EPIDURAL INFUSION

▶ Adult: 6.3–18.8 mg/hour, dose administered using a

1.25 mg/mL (0.125%) or 2.5 mg/mL (0.25%) solution;

maximum 400 mg per day

Acute pain, labour

▶ BY CONTINUOUS EPIDURAL INFUSION

▶ Adult: 6.25–12.5 mg/hour, dose administered using a

1.25 mg/mL (0.125%) solution; maximum 400 mg per

day

Acute pain, lumbar epidural block

▶ INITIALLY BY LUMBAR EPIDURAL

▶ Adult: 15–37.5 mg, then (by lumbar epidural)

15–37.5 mg, repeated when required at intervals of at

least 30 minutes, dose administered by intermittent

injection using a 2.5 mg/mL (0.25%) solution,

alternatively (by continuous epidural infusion)

12.5–18.8 mg/hour, dose administered using a

1.25 mg/mL (0.125%) or 2.5 mg/mL (0.25%) solution;

maximum 400 mg per day

Acute pain, field block

▶ BY REGIONAL ADMINISTRATION

▶ Adult: Up to 150 mg, dose administered using a

2.5 mg/mL (0.25%) solution

DOSES AT EXTREMES OF BODY-WEIGHT

▶ To avoid excessive dosage in obese patients, dose

should be calculated on the basis of ideal body-weight.

MARCAIN HEAVY ®

Intrathecal anaesthesia for surgery

▶ BY INTRATHECAL INJECTION

▶ Adult: 10–20 mg

IMPORTANT SAFETY INFORMATION

The licensed doses stated may not be appropriate in

some settings and expert advice should be sought.

Should only be administered by, or under the direct

supervision of, personnel experienced in their use, with

adequate training in anaesthesia and airway

management, and should not be administered

parenterally unless adequate resuscitation equipment is

available.

l CONTRA-INDICATIONS Application to the middle ear (can

cause ototoxicity). avoid injection into infected tissues . avoid injection into inflamed tissues . complete heart block . preparations containing preservatives should not be used

for caudal, epidural, or spinal block, or for intravenous

BNF 78 Local anaesthesia 1349

Anaesthesia

15