Wednesday, May 20, 2015

Comparison : Bupivacaine Heavy VS Bupivacaine Plain

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
Side Effects:
  • There were no differences in the adverse effects studied. Any possible advantage of hyperbaric bupivacaine needs to be confirmed in larger randomized trials.
References:
  1.  www.uptodate.com
  2. http://www.cochrane.org/CD005143/ANAESTH_does-denser-compared-normal-bupivacaine-given-lower-back-injection-give-more-effective-and-safer
  3. Product leaflets

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