Pankaine Spinal Tung (Bupivacaine Hydrochloride, Anhydrous)

Bupivacaine hydrochloride is employed in regional anaesthesia techniques that target the spinal and epidural spaces.

• Surgical anesthesia for lower abdominal, pelvic and lower‑limb procedures: Provides dense sensory block for the duration of surgery.
• Post‑operative pain control after cesarean section: Extends analgesia into the early recovery period.
• Chronic pain management via epidural infusion: Delivers continuous analgesia for refractory pain conditions.
• Diagnostic spinal procedures: Facilitates patient comfort during lumbar puncture or myelography.
• Labor analgesia: Offers effective pain relief during the first stage of labor.

• Bupivacaine blocks voltage‑gated sodium channels on neuronal membranes, stabilising the neuronal membrane and preventing the initiation and propagation of action potentials. This inhibition of nerve impulse transmission produces reversible loss of sensation and motor function in the targeted region, allowing surgical anesthesia and analgesia without systemic central nervous system depression.

Bupivacaine may cause a range of adverse reactions, from mild to potentially life‑threatening.

Common Side Effects

• Hypotension: Transient drop in blood pressure following sympathetic blockade.
• Bradycardia: Reduced heart rate due to vagal stimulation.
• Nausea: Mild to moderate nausea during or after the procedure.
• Pruritus: Itching, often associated with opioid adjuncts.
• Urinary retention: Difficulty voiding after spinal block.

Serious or Rare Side Effects

• Cardiac toxicity: Arrhythmias or cardiac arrest with high plasma concentrations.
• Central nervous system toxicity: Seizures, tinnitus, or metallic taste.
• Allergic reaction: Rash, urticaria, or anaphylaxis.
• Persistent neurological deficit: Prolonged motor or sensory block beyond expected duration.
• Spinal hematoma: Accumulation of blood in the epidural or subarachnoid space.
• Infection at injection site: Localized erythema or abscess formation.

When using Bupivacaine for spinal anesthesia, clinicians should observe standard safety protocols and patient‑specific considerations.

• Patient assessment: Evaluate cardiovascular status and allergy history before administration.
• Dose limitation: Adhere to recommended maximum dose to avoid systemic toxicity.
• Monitoring: Continuous ECG, blood pressure, and oxygen saturation during the procedure.
• Resuscitation readiness: Have lipid emulsion therapy and advanced cardiac life support equipment available.
• Contraindications: Avoid in patients with known hypersensitivity to amide‑type local anaesthetics.
• Store at ambient temperature: Keep in original container, protect from light and moisture.

Bupivacaine can interact with other agents that influence cardiac conduction or central nervous system activity.

Major Interactions (Avoid)

• Class III anti‑arrhythmics (e.g., amiodarone): May potentiate cardiotoxic effects.
• Beta‑blockers: Can exacerbate bradycardia and hypotension.
• Central nervous system depressants (e.g., benzodiazepines, opioids): Increase risk of respiratory depression.

Moderate Interactions (Monitor Closely)

• Calcium channel blockers: May enhance hypotensive response.
• Diuretics: Can alter plasma protein binding, affecting free drug levels.
• MAO inhibitors: Potentially increase neuro‑excitatory toxicity.