Overview
- intravenous regional anesthesia (Beer blockade) (accidental penetration of the drug into the bloodstream can Bufyl the development of acute systemic toxic reactions);
- paracervical block in obstetrics.
The drug should not be used in early pregnancy, unless the benefit to the mother does not exceed the actually
With caution, anesthesia with the drug is carried out in the following diseases and conditions:
- severe liver disease, severe renal failure;
- the use of antiarrhythmic drugs of the III class (for example, amiodarone);
- concomitant use of bupivacaine with other local anesthetics or drugs structurally similar to local amide type anesthetics, such as lb class antiarrhythmic drugs (e.g. lidocaine and mexiletine).
How to use: dosage and course of treatment
Intramuscularly or subcutaneously.
Local anesthesia should be performed by experienced specialists in an appropriately equipped room with the availability of equipment and preparations ready for immediate use necessary for monitoring cardiac activity and resuscitation. Personnel performing anesthesia should be qualified and trained in the technique of performing anesthesia, should be familiar with the diagnosis and treatment of systemic toxic reactions, adverse events Bufyl reactions and other complications.
The dose of any local anesthesia depends on the analgesic procedure, the area that needs to be anesthetized, the blood supply to the tissues, the depth of anesthesia and the degree of muscle relaxation required for the required duration of anesthesia, individual tolerance and physical condition of the patient. To achieve the required degree of anesthesia, the lowest possible dose should be administered.
Avoid rapid administration of a large volume of the drug. Under no circumstances should accidental intravascular administration of the drug be allowed. Before and during the administration of the drug, an aspiration test is recommended. The drug must be administered slowly, at a speed of 25-50 mg / min or fractionally, maintaining continuous verbal contact with the patient and controlling the heart rate.
The duration of anesthesia with the drug is such that for most indications of a single dose, it is enough.
The calculation of the maximum dose should be individual, it is necessary to take into account the physique and physical status of the patient, as well as the usual rate of systemic absorption at a particular injection site.
A single dose of the drug up to 225 mg with epinephrine (1: 200 000) and 175 mg without epinephrine can be used depending on the individualization of each case. Every 3 hours, repeated administration of the drug in these doses is allowed.
The maximum recommended daily dose for healthy adult patients with a body weight of 70 kg is 400 mg. The dose should be reduced for children, the elderly and debilitated patients and patients with diseases of the cardiovascular system and / or liver.
During surgery, additional administration of the drug is possible.
With the simultaneous use of narcotic analgesics, the dose of the drug must be reduced.
With prolonged administration of the drug in a patient, it is necessary to regularly monitor blood pressure, heart rate and other signs of potential toxicity. If toxic effects occur, the drug should be discontinued immediately.
The drug may only be diluted with compatible solvents, such as 0.9% sodium chloride solution, since dilution can change the properties of the drug and lead to bupivacaine precipitation. Dilution should be carried out only by qualified personnel with mandatory visual inspection for mechanical impurities and discoloration before administration. It is possible to use only 6 transparent solutions without visible particles. The solution of the drug is intended for single use only.
pharmachologic effect
Long-acting local anesthetic of the amide type. Reversibly blocks the conduction of an impulse along a nerve fiber, disrupting actually transport of sodium ions through sodium channels. It has a hypotensive effect, slows down the heart rate. May have a similar effect in the brain and myocardium.
The addition of a vasoconstrictor epinephrine leads to a decrease in the rate of absorption of the anesthetic and, as a result, to the strengthening and lengthening of the action of the drug.
Side effects
The frequency of adverse reactions is determined by the following categories: very frequent (> 1/10), frequent (from> 1/100 to 1/1000 to 1/10000 to 6.5 decreases.
In preparation for the introduction, it is necessary to avoid prolonged contact of the drug with metal objects, since metal ions can cause reactions at the injection site, manifested by pain and swelling.
When epinephrine is added to a solution of local anesthetic, it is necessary, if possible, to avoid their simultaneous use with monoamine oxidase inhibitors or tricyclic antidepressants, since it is possible to develop a persistent increase in blood pressure. If such simultaneous therapy is necessary, patients should be carefully monitored.
Concomitant use with vasopressor and uterotonic agents (ergot Bufyl can lead to a persistent increase in blood pressure and cerebrovascular complications.
Derivatives of phenothiazine and butyrophenone may reduce or reverse the pressor effect of epinephrine.
Questions, answers, reviews on the drug Bupivacaine
