Bupivacaine 0. 25 % solution for injection 10 ml Sure-Amp ampoules|
20 ampouleP£ 17. 50
Bupivacaine hydrochloride 5 mg per 1 mlBupivacaine 0. 5 %
solution for injection 10 ml Sure-Amp ampoules| 20 ampouleP
£ 18. 30
Bupivacaine 100 mg/ 20 ml ( 0. 5 %) solution for injection vials|
10 vialPs
Bupivacaine 50 mg/ 10 ml ( 0. 5 %) solution for injection ampoules|
10 ampouleP£ 17. 58
Bupivacaine hydrochloride anhydrous 40 mg per 1 mlBupivacain
Sintetica 40 mg/ml ( 4 %) solution for injection ampoules|
10 ampoulePs
▶Marcain(Aspen Pharma Trading Ltd)
Bupivacaine hydrochloride 2.5 mg per 1 mlMarcain 0. 25 % solution
for injection 10 ml Polyamp Steripack ampoules| 5 ampouleP
£ 7. 92
Bupivacaine hydrochloride 5 mg per 1 mlMarcain 0. 5 % solution
for injection 10 ml Polyamp Steripack ampoules| 5 ampouleP
£ 9. 25
Infusion
▶Bupivacaine hydrochloride (Non-proprietary)
Bupivacaine hydrochloride 1 mg per 1 mlBupivacaine
100 mg/ 100 ml ( 0. 1 %) infusion bags| 20 bagPs
Bupivacaine 250 mg/ 250 ml ( 0. 1 %) infusion bags| 20 bagP
£ 211. 72
Bupivacaine hydrochloride 1.25 mg per 1 mlBupivacaine
312. 5 mg/ 250 ml ( 0. 125 %) infusion bags| 20 bagP£ 216. 06Bupivacaine with adrenaline
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, bupivacaine hydrochloride p. 824 ,
adrenaline/epinephrine p. 136.
lINDICATIONS AND DOSE
Surgical anaesthesia
▶BY LUMBAR EPIDURAL, OR BY LOCAL INFILTRATION, OR BY
CAUDAL EPIDURAL
▶Child 12–17 years:(consult product literature)
Acute pain management
▶BY LUMBAR EPIDURAL, OR BY LOCAL INFILTRATION
▶Child 1–17 years:(consult product literature)IMPORTANT SAFETY INFORMATION
Adrenaline/epinephrine must be used in a low
concentration when administered with a local
anaesthetic. The total dose of adrenaline should not
exceed 5 micrograms/kg ( 1 mL/kg of a 1 in200 000
solution) and it is essential not to exceed a
concentration of 1 in200 000( 5 micrograms/mL) if more
than 50 mL of the mixture is to be injected.lCAUTIONS
CAUTIONS, FURTHER INFORMATIONIn patients with severe
hypertension or unstable cardiac rhythm, the use of
adrenaline with a local anaesthetic may be hazardous. For
these patients an anaesthetic without adrenaline should
be used.lINTERACTIONS→Appendix 1 : anaesthetics, local.
sympathomimetics, vasoconstrictor
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Bupivacaine with adrenaline (Non-proprietary)
Adrenaline (as Adrenaline acid tartrate) 5 microgram per 1 ml,
Bupivacaine hydrochloride 2.5 mg per 1 mlBupivacaine
25 mg/ 10 ml ( 0. 25 %) / Adrenaline (base) 50 micrograms/ 10 ml ( 1 in
200 , 000 ) solution for injection ampoules| 10 ampouleP£ 40. 00
Adrenaline (as Adrenaline acid tartrate) 5 microgram per 1 ml,
Bupivacaine hydrochloride 5 mg per 1 mlBupivacaine 50 mg/ 10 ml
( 0. 5 %) / Adrenaline (base) 50 micrograms/ 10 ml ( 1 in 200 , 000 ) solution
for injection ampoules| 10 ampouleP£ 45. 00
Levobupivacaine
lINDICATIONS AND DOSE
Surgical anaesthesia|Acute pain
▶BY REGIONAL ADMINISTRATION
▶Child:Doses adjusted according to child’s physical
status and nature of procedure, seek expert advice
(consult product literature or local protocols)
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal body-weight.lUNLICENSED USENot licensed for use in children except
for analgesia by ilioinguinal or iliohypogastric block.IMPORTANT SAFETY INFORMATION
The licensed doses stated may not be appropriate in
some settings and expert advice should be sought.
Should only be administered by, or under the direct
supervision of, personnel experienced in their use, with
adequate training in anaesthesia and airway
management, and should not be administered
parenterally unless adequate resuscitation equipment is
available.lCONTRA-INDICATIONSApplication to the middle ear (can
cause ototoxicity).avoid injection into infected tissues.
avoid injection into inflamed tissues.complete heart block
.preparations containing preservatives should not be used
for caudal, epidural, or spinal block, or for intravenous
regional anaesthesia (Bier’s block).should not be applied
to damaged skin
CONTRA-INDICATIONS, FURTHER INFORMATION
▶Injection siteLocal anaesthetics should not be injected into
inflamed or infected tissues nor should they be applied to
damaged skin. Increased absorption into the blood
increases the possibility of systemic side-effects, and the
local anaesthetic effect may also be reduced by altered
local pH.
lCAUTIONSCardiovascular disease.children (consider dose
reduction).debilitated patients (consider dose reduction).
epilepsy.hypovolaemia.impaired cardiac conduction.
impaired respiratory function.myasthenia gravis.shock
lINTERACTIONS→Appendix 1 : anaesthetics, local
lSIDE-EFFECTS
▶Common or very commonAnaemia.back pain.dizziness.
fever.headache.hypotension.nausea.vomiting
▶Frequency not knownAngioedema.apnoea.arrhythmias.
asthenia.atrioventricular block.bladder disorder.cardiac
arrest.drowsiness.eye disorders.faecal incontinence.
flushing.loss of consciousness.muscle twitching.muscle
weakness.nerve disorders.neurological injury.oral
hypoaesthesia.paralysis.priapism.respiratory disorders.
seizure.sensation abnormal.skin reactions.sneezing.
sweat changes.syncope.vision blurred
SIDE-EFFECTS, FURTHER INFORMATIONThe systemic
toxicity of local anaesthetics mainly involves the central
nervous and cardiovascular systems. Systemic toxicity can
occur due to inadvertent intravascular injection. The onset
of toxicity can be unpredictable and delayed. Monitor as
per local protocol for at least 30 minutes after
administration.
lALLERGY AND CROSS-SENSITIVITY
▶Hypersensitivity and cross-sensitivityHypersensitivity
reactions occur mainly with the ester-type local
anaesthetics, such as tetracaine; reactions are less
frequent with the amide types, such as articaine,
bupivacaine, levobupivacaine, lidocaine, mepivacaine,
prilocaine, and ropivacaine. Cross-sensitivity reactions
may be avoided by using the alternative chemical type.BNFC 2018 – 2019 Local anaesthesia 825
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