regional anaesthesia (Bier’s block). should not be applied
CONTRA-INDICATIONS, FURTHER INFORMATION
▶ Injection site Local anaesthetics should not be injected into
inflamed or infected tissues nor should they be applied to
damaged skin. Increased absorption into the blood
increases the possibility of systemic side-effects, and the
local anaesthetic effect may also be reduced by altered
l INTERACTIONS → Appendix 1: anaesthetics, local
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 systemic toxicity of local anaesthetics 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
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 Large doses during delivery can cause
neonatal respiratory depression, hypotonia, and
bradycardia after epidural block.
Dose adjustments Use lower doses for intrathecal use
l BREAST FEEDING Amount too small to be harmful.
l HEPATIC IMPAIRMENT Manufacturer advises use with
caution in advanced liver dysfunction.
l RENAL IMPAIRMENT Use with caution in severe
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: solution for
injection, infusion, solution for infusion
▶ Bupivacaine hydrochloride (Non-proprietary)
Bupivacaine hydrochloride 2.5 mg per 1 ml Bupivacaine
25mg/10ml (0.25%) solution for injection vials | 10 vial P s
Bupivacaine 0.25% solution for injection 10ml Sure-Amp ampoules | 20 ampoule P £17.50 DT = £17.50
Bupivacaine hydrochloride 5 mg per 1 ml Bupivacaine 0.5%
solution for injection 10ml Sure-Amp ampoules | 20 ampoule P £18.30 DT = £18.30
Bupivacaine 100mg/20ml (0.5%) solution for injection vials | 10 vial P s
Bupivacaine 50mg/10ml (0.5%) solution for injection ampoules | 10 ampoule P £7.56–£17.58 DT = £7.56
Bupivacaine hydrochloride anhydrous 40 mg per 1 ml Bupivacain
Sintetica 40mg/ml (4%) solution for injection ampoules | 10 ampoule P s
▶ Marcain (Aspen Pharma Trading Ltd)
Bupivacaine hydrochloride 2.5 mg per 1 ml Marcain 0.25% solution
for injection 10ml Polyamp Steripack ampoules | 5 ampoule P £7.92 DT = £7.92
Bupivacaine hydrochloride 5 mg per 1 ml Marcain 0.5% solution
for injection 10ml Polyamp Steripack ampoules | 5 ampoule P £9.25 DT = £9.25
▶ Bupivacaine hydrochloride (Non-proprietary)
Bupivacaine hydrochloride 1 mg per 1 ml Bupivacaine
100mg/100ml (0.1%) infusion bags | 20 bag P s
Bupivacaine 250mg/250ml (0.1%) infusion bags | 20 bag P £243.48
Bupivacaine hydrochloride 1.25 mg per 1 ml Bupivacaine
312.5mg/250ml (0.125%) infusion bags | 20 bag P £248.47
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, bupivacaine hydrochloride p. 1349,
adrenaline/epinephrine p. 222.
▶ BY LUMBAR EPIDURAL, OR BY LOCAL INFILTRATION, OR BY
▶ Adult: (consult product literature)
▶ BY LUMBAR EPIDURAL, OR BY LOCAL INFILTRATION
▶ Adult: (consult product literature)
Adrenaline/epinephrine must be used in a low
concentration when administered with a local
anaesthetic. The total dose of adrenaline should not
exceed 500 micrograms and it is essential not to exceed a
concentration of 1 in 200 000 (5 micrograms/mL) if more
than 50 mL of the mixture is to be injected.
CAUTIONS, FURTHER INFORMATION 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
l INTERACTIONS → Appendix 1: anaesthetics, local . sympathomimetics, vasoconstrictor
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Bupivacaine with adrenaline (Non-proprietary)
Adrenaline (as Adrenaline acid tartrate) 5 microgram per 1 ml,
Bupivacaine hydrochloride 2.5 mg per 1 ml Bupivacaine
25mg/10ml (0.25%) / Adrenaline (base) 50micrograms/10ml (1 in
200,000) solution for injection ampoules | 10 ampoule P £46.00
Adrenaline (as Adrenaline acid tartrate) 5 microgram per 1 ml,
Bupivacaine hydrochloride anhydrous 2.5 mg per
1 ml Carbostesin-adrenaline 0.25% / 100micrograms/20ml (1 in
200,000) solution for injection ampoules | 1 ampoule P s
Carbostesin-adrenaline 0.25% / 25micrograms/5ml (1 in 200,000)
solution for injection ampoules | 1 ampoule P s
Adrenaline (as Adrenaline acid tartrate) 5 microgram per 1 ml,
Bupivacaine hydrochloride 5 mg per 1 ml Bupivacaine 50mg/10ml
(0.5%) / Adrenaline (base) 50micrograms/10ml (1 in 200,000) solution
for injection ampoules | 10 ampoule P £51.75 DT = £51.75
Adrenaline (as Adrenaline acid tartrate) 5 microgram per 1 ml,
injection ampoules | 1 ampoule P s
Carbostesin-adrenaline 0.5% / 100micrograms/20ml (1 in 200,000)
solution for injection ampoules | 1 ampoule P s
▶ BY CONTINUOUS EPIDURAL INFUSION
▶ Adult: 12.5–18.75 mg/hour, dose administered using a
1.25 mg/mL (0.125%) or 2.5 mg/mL (0.25%) solution;
▶ Adult: 15–25 mg, repeated at intervals of at least
15 minutes, dose administered using a 2.5 mg/mL
(0.25%) solution; maximum 400 mg per day
▶ BY CONTINUOUS EPIDURAL INFUSION
▶ Adult: 5–12.5 mg/hour, dose administered using a
1.25 mg/mL (0.125%) solution; maximum 400 mg per
Surgical anaesthesia, peripheral nerve block
▶ Adult: 2.5–150 mg, dose administered using a
2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution
Surgical anaesthesia, peribulbular nerve block
▶ Adult: 37.5–112.5 mg, dose administered using a
Surgical anaesthesia for caesarean section
▶ Adult: 75–150 mg, to be given over 15 –20 minutes,
dose administered using a 5 mg/mL (0.5%) solution
▶ Adult: 50–150 mg, to be given over 5 minutes, dose
administered using a 5 mg/mL (0.5%) or 7.5 mg/mL
▶ Adult: 15 mg, dose administered using a 5 mg/mL
▶ Adult: 2.5–150 mg, dose administered using a
DOSES AT EXTREMES OF BODY-WEIGHT
▶ To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal body-weight.
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
l CONTRA-INDICATIONS Application to the middle ear (can
for caudal, epidural, or spinal block, or for intravenous
regional anaesthesia (Bier’s block). should not be applied
CONTRA-INDICATIONS, FURTHER INFORMATION
▶ Injection site Local anaesthetics should not be injected into
inflamed or infected tissues nor should they be applied to
damaged skin. Increased absorption into the blood
increases the possibility of systemic side-effects, and the
local anaesthetic effect may also be reduced by altered
l CAUTIONS Cardiovascular disease . debilitated patients
(consider dose reduction). elderly (consider dose
reduction). epilepsy . hypovolaemia . impaired cardiac
conduction . impaired respiratory function . myasthenia
l INTERACTIONS → Appendix 1: anaesthetics, local
weakness . nerve disorders . neurological injury . oral
SIDE-EFFECTS, FURTHER INFORMATION The systemic
toxicity of local anaesthetics mainly involves the central
nervous and cardiovascular systems. Systemic toxicity can
occur due to inadvertent intravascular injection. The onset
of toxicity can be unpredictable and delayed. Monitor as
per local protocol for at least 30 minutes after
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 Large doses during delivery can cause
neonatal respiratory depression, hypotonia, and
bradycardia after epidural block. Avoid if possible in the
first trimester—toxicity in animal studies. May cause fetal
distress syndrome. Do not use for paracervical block in
obstetrics. Do not use 7.5 mg/mL strength in obstetrics.
l BREAST FEEDING Amount too small to be harmful.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
impairment or patients with reduced hepatic blood flow
l DIRECTIONS FOR ADMINISTRATION For 1.25 mg/mL
concentration dilute standard solutions with sodium
l PRESCRIBING AND DISPENSING INFORMATION
Levobupivacaine is an isomer of bupivacaine.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Levobupivacaine (Non-proprietary)
Levobupivacaine (as Levobupivacaine hydrochloride) 2.5 mg per
1 ml Levobupivacaine 25mg/10ml solution for injection ampoules | 5 ampoule P £9.00 (Hospital only)
Levobupivacaine (as Levobupivacaine hydrochloride) 5 mg per
1 ml Levobupivacaine 50mg/10ml solution for injection ampoules | 5 ampoule P £10.35 (Hospital only)
Levobupivacaine (as Levobupivacaine hydrochloride) 7.5 mg per
1 ml Levobupivacaine 75mg/10ml solution for injection ampoules | 5 ampoule P £15.45 (Hospital only)
Levobupivacaine (as Levobupivacaine hydrochloride) 2.5 mg per
1 ml Chirocaine 25mg/10ml solution for injection ampoules |
10 ampoule P £14.11 (Hospital only)
Levobupivacaine (as Levobupivacaine hydrochloride) 5 mg per
1 ml Chirocaine 50mg/10ml solution for injection ampoules | 10 ampoule P £16.15 (Hospital only)
Levobupivacaine (as Levobupivacaine hydrochloride) 7.5 mg per
1 ml Chirocaine 75mg/10ml solution for injection ampoules | 10 ampoule P £24.23 (Hospital only)
Comments
Post a Comment
اكتب تعليق حول الموضوع