Bupivacaine

INTRODUCTION

Indications

Local or regional anesthesia or analgesia for surgical, obstetric, or diagnostic procedures.

Action

Local anesthetics inhibit initiation and conduction of sensory nerve impulses by altering the influx of sodium and efflux of potassium in neurons, slowing or stopping pain transmission. Therapeutic Effects: Decreased pain or induction of anesthesia; low doses have minimal effect on sensory or motor function; higher doses may produce complete motor blockade.

Adverse Reactions/Side Effects

CNS: SEIZURES, anxiety, dizziness, headache, irritability. EENT: blurred vision, tinnitus. CV: CARDIOVASCULAR COLLAPSE, arrhythmias, bradycardia, hypotension. GI: nausea, vomiting. GU: urinary retention. Derm: pruritus. F and E: metabolic acidosis. Neuro: circumoral tingling/numbness, tremor. Misc: allergic reactions, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Monitor cardiac symptoms at rest and during exercise, and be alert for signs of severe cardiac insufficiency due to cardiac arrest (cardiovascular collapse). Seek immediate medical assistance if symptoms of cardiac arrest develop, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea.

• Monitor signs of allergic reactions, including pulmonary symptoms (laryngeal edema, bronchospasm, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report an unusually slow heart rate (bradycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Be alert for other signs of systemic toxicity, including confusion, nervousness, tremor, headache, blurred or double vision, nausea, vomiting, slurred speech, ringing in ears, tremors, twitching, difficulty breathing, hypotension, severe dizziness or fainting, and unusually slow heart rate. Report these signs to the physician or nursing staff immediately.

• Monitor signs of metabolic acidosis, including headache, lethargy, stupor, seizures, vision disturbances, increased respiration, cardiac arrhythmias, weakness, and GI symptoms (nausea, vomiting, and/or abdominal pain). Notify physician or nursing staff immediately if these signs occur.

• If used postsurgically for continuous nerve block, use appropriate pain scales and sensory testing to document level of local anesthesia.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Because of the risk of arrhythmias and cardiac arrest, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and ...