Medical term:

Sensorcaine

bupivacaine

(byoo-pi-vi-kane) ,

Marcaine

(trade name),

Sensorcaine

(trade name)

Classification

Therapeutic: epidural local anesthetics

Pregnancy Category: C

Indications

Local or regional anesthesia or analgesia for surgical, obstetric, or diagnostic procedures.

Action

Local anesthetics inhibit initiation and conduction of sensory nerve impulses by altering the influx of sodium and efflux of potassium in neurons, slowing or stopping pain transmission.

Therapeutic effects

Decreased pain or induction of anesthesia; low doses have minimal effect on sensory or motor function; higher doses may produce complete motor blockade.

Pharmacokinetics

Absorption: Systemic absorption follows epidural administration, but amount absorbed depends on dose.

Distribution: If systemic absorption occurs, this agent is widely distributed and crosses the placenta.

Metabolism and Excretion: Small amounts that may reach systemic circulation are mostly metabolized by the liver; 6% excreted unchanged in the urine.

Half-life: 1.5—5 hr (after epidural use).

Time/action profile (analgesia)

ROUTE	ONSET	PEAK	DURATION
Epidural	10–30 min	unknown	2–8 hr†

†Duration of anesthetic block

Contraindications/Precautions

Contraindicated in: Hypersensitivity; cross-sensitivity with other amide local anesthetics may occur (ropivacaine, lidocaine, mepivacaine, prilocaine); Contains bisulfites and should be avoided in patients with known intolerance; Obstetric: Obstetrical paracervical block anesthesia.

Use Cautiously in: Concurrent use of other local anesthetics; Liver disease; Concurrent use of anticoagulants (including low-dose heparin and low-molecular-weight heparins/heparinoids) ↑ the risk of spinal/epidural hematomas; Pediatric: Children <12 yr (safety not established).

Adverse Reactions/Side Effects

Central nervous system

seizures (life-threatening)
anxiety
dizziness
headache
irritability

Ear, Eye, Nose, Throat

blurred vision
tinnitus

Cardiovascular

cardiovascular collapse (life-threatening)
arrhythmias
bradycardia
hypotension

Gastrointestinal

nausea
vomiting

Genitourinary

urinary retention

Dermatologic

pruritus

Fluid and Electrolyte

metabolic acidosis

Neurologic

circumoral tingling/numbness
tremor

Miscellaneous

allergic reactions
fever

Interactions

Drug-Drug interaction

Additive toxicity may occur with concurrent use of other amide localanesthetics (includinglidocaine, mepivacaine, and prilocaine ).Use of solution containing epinephrine with MAO inhibitors may cause hypertension.

Route/Dosage

Solutions containing preservatives should not be used for caudal or epidural blocks.

Epidural (Adults and Children > 12 yr) 10–20 mL of 0.25% (partial to moderate block), 0.5% (moderate to complete block), or 0.75% (complete block) solution. Administer in increments of 3–5 mL allowing sufficient time to detect toxic signs/symptoms of inadvertent IV or IT administration. A test dose of 2–3 mL of 0.5% with epinephrine solution is recommended prior to epidural blocks.

Caudal block: (Adults and Children > 12 yr) 15–30 mL of 0.25% or 0.5% solution. A test dose of 2–3 mL of 0.5% with epinephrine solution is recommended prior to caudal blocks.

Peripheral nerve block: (Adults and Children > 12 yr) 5 mL of 0.25% or 0.5% solution (maximum dose = 400 mg).

Sympathetic nerve block: (Adults and Children > 12 yr) 20–50 mL of 0.25% solution.

Dental block: (Adults and Children > 12 yr) 1.8–3.6 mL per site of 0.5% with epinephrine solution.

Local Infiltration: (Adults and Children > 12 yr) 0.25% solution infiltrated locally (maximum dose = 175 mg).

Availability (generic available)

Solution for injection (with and without preservatives): 0.25%, 0.5%, 0.75%

In combination with: epinephrine 1:200,000.

Nursing implications

Nursing assessment

Systemic Toxicity: Assess for systemic toxicity (circumoral tingling and numbness, ringing in ears, metallic taste, dizziness, blurred vision, tremors, slow speech, irritability, twitching, seizures, cardiac dysrhythmias). Report to physician or other health care professional.
Monitor BP, HR, and respiratory rate continuously while patient is receiving this medication.
Monitor for return of sensation after procedure.

Potential Nursing Diagnoses

Acute pain (Indications)
Impaired physical mobility

Implementation

See Route and Dosage section.

Patient/Family Teaching

Instruct patient to notify nurse if signs or symptoms of systemic toxicity occur.
Advise patient to request assistance during ambulation until orthostatic hypotension and motor deficits are ruled out.

Evaluation/Desired Outcomes

Decrease in postoperative pain without unwanted sensory or motor deficits.

Sensorcaine

(sĕn′sər-kān′)

A trademark for the drug bupivacaine hydrochloride.

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