Bupi

Indications

Bupivacaine is a long-acting local anaesthetic. It numbs a part of the body so that surgery or a procedure can be done without pain. It is used for nerve blocks, epidural pain relief in labour and after surgery, and numbing around a wound. The heavy form (bupivacaine mixed with Dextrose) is used for spinal anaesthesia, for example in caesarean section and operations on the lower abdomen, hips and legs.

How It Works

Bupivacaine blocks sodium channels in nerves, which stops nerves from sending pain signals to the brain. The numbness lasts for several hours, longer than many other local anaesthetics.

Dosage and Administration

Bupivacaine is given only by an anaesthetist or doctor in a hospital or operating theatre, by injection near nerves, into the spine or into the epidural space. The dose and strength are chosen for each person and procedure, based on the type of block, body size and health, and the doctor keeps within safe total-dose limits. It is given as prescribed; it is not for use at home.

Interactions

Tell the doctor about all your medicines. Using other local anaesthetics such as Lidocaine at the same time adds to the total dose. Heart rhythm medicines such as Amiodarone, and beta-blockers, may increase effects on the heart. Blood thinners such as Warfarin, Heparin, Clopidogrel, Apixaban or Rivaroxaban raise the risk of bleeding around the spine with spinal or epidural injections, so the timing of doses must be planned with the doctor.

Contraindications

• Allergy to bupivacaine or other amide local anaesthetics such as Lidocaine.
• Intravenous regional anaesthesia (Bier's block).
• The 0.75% strength for epidural pain relief in labour.
• For spinal or epidural use: bleeding disorders or full-dose blood thinners, infection at the injection site, severe shock or very low blood pressure, and raised pressure inside the skull.

Side Effects

Common: low blood pressure, nausea, vomiting, slow heartbeat, shivering, itching, difficulty passing urine for a short time, and headache after a spinal injection. Numbness and weakness are expected until the medicine wears off.

Tell the medical staff at once if you notice numbness around the mouth, a metallic taste, ringing in the ears, dizziness, confusion, twitching, an irregular heartbeat, or signs of allergy such as rash or difficulty breathing. Get urgent medical help after you go home if numbness or weakness lasts much longer than expected, or you have a severe headache, back pain with fever, or loss of bladder or bowel control.

Pregnancy and Lactation

Bupivacaine is widely used for epidural pain relief in labour and for spinal anaesthesia in caesarean section. The 0.75% strength is not used in labour. Only very small amounts pass into breast milk, and breastfeeding can usually continue after the procedure.

Precautions and Warnings

It must be given where equipment and staff for resuscitation are available. Extra care is needed in heart rhythm problems, heart failure, liver disease, older people and people who are very unwell. Protect the numb area from heat and injury until feeling returns. Do not drive or operate machines until full feeling and strength have come back.

Overdose

Too much bupivacaine in the blood can cause fits, dangerous heart rhythm problems and cardiac arrest. This is managed immediately by the medical team with oxygen, medicines to stop fits, lipid emulsion and resuscitation.

Therapeutic Class

Amide local anaesthetic.

Storage

Store below 30°C, do not freeze, and keep away from light. It is stored and prepared by the hospital pharmacy or theatre staff. Ampoules are for single use only; any unused solution is discarded.