Bupivacaine

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Bupivacaine
Systematic (IUPAC) name
1-butyl-N-(2,6-dimethylphenyl) piperidine-2-carboxamide
Identifiers
CAS number	36637-18-0
ATC code	N01BB01
PubChem	2474
DrugBank	APRD00247
Chemical data
Formula	C₁₈H₂₈N₂O
Mol. mass	288.43 g/mol
Pharmacokinetic data
Bioavailability	n/a
Metabolism	hepatic
Half life	3.5 hours (adults) 8.1 hours (neonates)
Excretion	Renal, 4–10%
Therapeutic considerations
Pregnancy cat.	A(AU)
Legal status	Prescription Only (S4)(AU)
Routes	parenteral, topical

Bupivacaine (rINN) (IPA: [bjuˈpɪvəkeɪn]) is a local anaesthetic drug belonging to the amino amide group. It is commonly marketed by AstraZeneca under various trade names including Marcain, Marcaine and Sensorcaine.

1 Clinical use
2 Developments
3 References
4 External links

[edit] Clinical use

[edit] Indications

Bupivacaine is indicated for local anaesthesia including infiltration, nerve block, epidural and intrathecal anaesthesia. Bupivacaine is often administered by epidural injection prior to total hip arthroplasty. It is also commonly injected into surgical wound sites to reduce pain for up to 20 hours after surgery.

Bupivacaine is sometimes co-administered with adrenaline to prolong the duration of action, fentanyl for epidural analgesia, or glucose.

[edit] Contraindications

Bupivacaine is contraindicated for IV regional anaesthesia (IVRA).

[edit] Adverse effects

Compared to other local anaesthetics, bupivacaine is markedly cardiotoxic. However, adverse drug reactions (ADRs) are rare when it is administered correctly. Most ADRs relate to administration technique (resulting in systemic exposure) or pharmacological effects of anesthesia, however allergic reactions can rarely occur.

Systemic exposure to excessive quantities of bupivacaine mainly result in central nervous system (CNS) and cardiovascular effects – CNS effects usually occur at lower blood plasma concentrations and additional cardiovascular effects present at higher concentrations, though cardiovascular collapse may also occur with low concentrations. CNS effects may include CNS excitation (nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision, seizures) followed by depression (drowsiness, loss of consciousness, respiratory depression and apnea). Cardiovascular effects include hypotension, bradycardia, arrhythmias, and/or cardiac arrest – some of which may be due to hypoxemia secondary to respiratory depression.^[1]

[edit] Treatment of overdose: "Lipid rescue"

There is animal evidence^[2]^[3] that Intralipid, a commonly available intravenous lipid emulsion, can be effective in treating severe cardiotoxicity secondary to local anaesthetic overdose, and human case reports of successful use in this way.^[4]^[5] Schemes to publicise this use more widely have been published.^[6]

[edit] Developments

Levobupivacaine is the S-enantiomer of bupivacaine, with a longer duration of action and produces less vasodilation. Durect Corporation is developing a biodegradable controlled-release drug delivery system for post surgery. It is currently in Phase II.

[edit] References

^ Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3
^ Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology 1998; 88: 1071-5.
^ Weinberg G, Ripper R, Feinstein DL, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Regional Anesthesia and Pain Medicine 2003; 28: 198-202..
^ Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB. Successful Use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 2006;105:217-8. PMID 16810015
^ Litz, RJ, Popp M, Stehr S N, Koch T. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia 2006;61:800-1.
^ Picard J, Meek T. Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob. Anaesthesia 2006;61:107-9. PMID 16430560