bupivacaine (Marcaine, Sensorcaine, Exparel)

Introduction

Tradenames: Marcaine, Sensorcaine.

Indications

• local anesthesia
  • labor pain
  • postoperative pain
• used in "blocks" for anesthesia & analgesia
  • sympathetic block
  • caudal or epidural block
  • retrobulbar block
  • liposomal bupivacaine (Exparel) FDA-approved for post-operative nerve block after shoulder surgery
• spinal anesthesthia associated with cesarean section

Contraindications

• use with caution in patients with liver disease
• do not use in children < 12 years of age
• do not use for spinal anesthesia in children < 18 years of age

Dosage

• caudal block (with or without epinephrine)
  • adults: 15-30 mL of 0.25% or 0.5%
  • children: 1-3.7 mg/kg
• epidural block (other than caudal block)
  • adults: 10-20 mL of 0.25% or 0.5%
  • children: 1.25 mg/kg/dose
• peripheral nerve block:
  • 5 mL dose of 0.25% or 0.5% (12.5-25 mg)
  • maximum:
    • 2.5 mg/kg (without epinephrine)
    • 3 mg/kg (with epinephrine)
    • up to 400 mg/day
• sympathetic nerve block
  • 25-50 mL of 0.25% solution without epinephrine

Injection: 0.25%, 0.5%, 0.75% with or without epinephrine.

Pharmacokinetics

• onset of action 2-15 minutes depending upon site of injection
• duration 3-7 hours (longer acting local anesthetic than lidocaine)
• highly protein bound (low transfer across placenta)
• co-administration of epinephrine prolongs the action & localizes the anesthesia
• small amount (6%) excreted in urine

elimination via liver

elimination via kidney

1/2life = 1.5-5 hours

Adverse effects

• not common (1-10%, dose-related)
  • cardiac arrest*, hypotension, bradycardia, palpitations, seizures*, restlessness, anxiety, dizziness, weakness, nausea/vomiting, blurred vision, tinnitus, apnea
• other
  • confusion
  • bradycardia
  • drowsiness
  • paresthesias
  • agitation
  • tremors
  • psychosis
  • visual disturbances
  • respiratory depression
  • urticaria
  • allergic reactions
  • sulfite reactions in sulfite-containing preparations

* cardiac arrest & convulsions associated with high plasma concentrations after inadvertant intravascular administration

Mechanism of action

• amide-type local anesthetic
• reversibly blocks nerve conduction in all nerve fibers (sensory, motor & autonomic fibers)
• decreases permeability of nerves to Na+
• increases threshold of excitability
• prevents propagation of action potential
• autonomic activity lost 1st, followed by sensory & motor function

More general terms

• local anesthetic

More specific terms

• levobupivacaine (Chirocaine)

Component of

• bupivacaine/meloxicam
• bupivacaine/lidocaine/povidone iodine/triamcinolone
• bupivacaine/lidocaine/povidone iodine
• bupivacaine/isopropanol/lidocaine/povidone iodine
• bupivacaine/isopropanol/lidocaine/methylprednisolone/povidone iodine
• bupivacaine/h2o/isopropanol/lidocaine/methylprednisolone/povidone iodine/sodium chloride
• bupivacaine/dexamethasone/isopropanol/povidone iodine
• betamethasone/bupivacaine/isopropanol/povidone iodine
• bupivacaine/sufentanil
• bupivacaine/lidocaine
• bupivacaine/epinephrine/fentanyl
• bupivacaine/citrate/sufentanil
• bupivacaine/epinephrine
• bupivacaine/hydromorphone
• bupivacaine/fentanyl

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2474
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=64737
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5282419
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=117963
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=92253