Table 1: Comparison between Bupivacaine Heavy and
Bupivacaine Plain
Agents
|
Properties
|
Duration
|
Distribution
|
Pharmacokinetics
|
ADRs
|
Bupivacaine Heavy 0.5
%
(MARCAINE® Spinal
Heavy 5 mg/ml solution for Injection)
|
Contains glucose
rendering is hyperbaric
|
Spinal
administration: small dose with a relatively low concentration and short
duration of action. Duration of analgesia: 2- 3 h
|
Initial distribution
into the subarachnoid space is markedly influenced by gravity.
|
-Partition coeff:
2.75
-Maximum plasma
concentration: 0.4 mg/ml every 100 mg injected.
-Total plasma
clearance: 0.58 L/min.
-Vd: 73 L
-Elimination half
life: 2.7 h
|
No significant
differences between both
|
Bupivacaine Plain 0.5
%
(PIVAKAN 0.5 % w/v
(Plain) Injection)
|
Absence of glucose;
considered isobaric (slightly hypobaric at 37oC and slightly
hyperbaric at 20oC)
|
Produces lower level
of block, for a longer duration than the hyperbaric solution.
Duration of
analgesia: 3 – 4 h in lower thoracic and lumbar segments.
|
Spread is only
marginally affected by gravity
|
Effectiveness:
- review found that intrathecal hyperbaric bupivacaine had a more rapid onset of sensory blockade at the 4th thoracic vertebra (T4) level than isobaric bupivacaine.
- Plain bupivacaine (ie, slightly hypobaric, prepared in saline) may also be used for spinal anesthesia for cesarean delivery.
- The literature comparing safety and efficacy of hyperbaric with isobaric bupivacaine for CD is inconclusive
- There were no differences in the adverse effects studied. Any possible advantage of hyperbaric bupivacaine needs to be confirmed in larger randomized trials.
- www.uptodate.com
- http://www.cochrane.org/CD005143/ANAESTH_does-denser-compared-normal-bupivacaine-given-lower-back-injection-give-more-effective-and-safer
- Product leaflets
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