Parenteral Manual

Bupivacaine HCl

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
MARCAINE®
Classification: 
Local anesthetic
Revised Date: 
November 2011
Indications: 
  • Peripheral nerve block, infiltration, sympathetic blockade, caudal, epidural, retrobulbar block
Reconstitution and Stability: 
  • Partially used bottles which do not contain preservatives should be discarded
  • Solutions that are cloudy, discoloured, or contain crystals should be discarded
  • Solutions that do not contain epinephrine may be autoclaved
  • Store at room temperature
  •  Availability = 0.25% with epinephrine
                          0.25% plain
                          0.5% plain
                          0.75% plain
Compatibility: 

- Solutions Compatible: 0.9% NaCl

- Additives/Above Cassette Compatible: fentanyl citrate, morphine, epinephrine, hydromorphone

- Y-site Compatible: no information

- Incompatible: do not mix with any other drug

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES
IM NO
IV Direct

NO
IV Intermittent Infusion NO
IV Continuous Infusion NO
Epidural YES, use preservative-free bupivacaine and dilute with preservative-free NS
Usual dilution: 1 mg/mL
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • Individualized, varying with the anesthetic procedure, the degree of anesthesia required and the patient response.  Use lowest effective dose.

PEDIATRIC:  

  • 2-3 mg/kg epidurally(Maximum: 3 mg/kg)
  • Continuous epidural infusion: 0.1 mg - 0.5 mg/kg/hr 

ADOLESCENT/ADULT:          

  • Usual single dose:  100 mg without epinephrine (Max: 175 mg)   
                                     150 mg with epinephrine (Max: 225 mg)
  • Maximum daily dose: 400 mg
                                     320 mg in continuous epidural anesthesia
  • Maximum frequency every 3 hours

 

Potential hazards of parenteral administration: 
  • Repeated or high doses or inadvertent intravascular injection may cause serious CNS effects such as tremors, convulsions, respiratory arrest; and cardiovascular effects such as myocardial depression, hypotension, cardiovascular collapse
  • Rarely, tissue necrosis and sloughing may occur at injection site
  • Do not use if patients have known hypersensitivity to PABA or parabens
Notes: 
  • Relatively long acting agent (duration 1.5-8.5 hours depending on route)
  • Solutions containing epinephrine should not be used in anesthesia of digits, ear, nose or penis
  • Should not be used for topical anesthesia                                                   
  • Solutions containing preservatives should not be used for epidural or caudal block    
  • Resuscitative equipment and drugs for treatment of adverse effects should be readily available
  • When solutions containing epinephrine are used the usual cautions for epinephrine apply
  • Use with caution in patients with liver disease

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