Understanding Anesthesiology - The Global Regional Anesthesia ...

BUPIVACAINE
Class
Local anesthetic. Used in infiltration anesthesia, spinal
and epidural anesthesia and other regional anesthesia
techniques.
Mechanism of Action
Sodium channel blocker
Dose
Maximum 2mg/kg without epinephrine
Maximum 3 mg/kg with epinephrine
Safe dose depends on where and how it is being administered.
For example, absorption from intercostal administration
is greater than for administration in adipose tissue.
Onset
Infiltration: 2-10 minutes
Effects
Local anesthetics should not have systemic effects if
used appropriately. If high plasma levels are achieved
due to incorrect dosing or inadvertent intravascular injection
then the symptoms manifest firstly in the central
nervous system and then in the cardiovascular system
where hypotension, heart block and other arrhythmias
may occur. Premonitory signs and symptoms are perioral
numbness, metallic taste, tinnitus, restlessness , dizziness
and tremors. Seizures, respiratory and circulatory
depression / arrest may occur. The treatment is supportive
care and the use of Intralipid. Administration of benzodiazepines
will increase the seizure threshold.
High intravascular concentrations of local anesthetics
may potentiate the effects of muscle relaxants (both depolarizing
and non-depolarizing).
Epidural: 10-30 minutes
Spinal: