Markain is a long-acting local anesthetic.
Release form and composition
Markaina dosage form - injection solution (20 ml each in bottles, 5 bottles in carton packs).
The active ingredient of the drug is bupivacaine hydrochloride. In 1 ml of its solution contains 5 mg.
Indications for use
Markain is used for various types of local anesthesia (in particular, for anesthesia for injuries and surgical interventions, including caesarean section, during labor and painful diagnostic procedures, for example, arthroscopy):
- Caudal or lumbar epidural block;
- Local infiltration anesthesia;
- Retrobulbar (regional) anesthesia.
- Conductive anesthesia (including the blockade of nerves in the head and neck, the blockade of large and small nerves, intercostal blockade).
- Diseases of the central nervous system;
- Children's age up to 2 years;
- Hypersensitivity to the components of the drug or other local anesthetics of the amide type.
Additional contraindications for caudal and lumbar anesthesia are:
- Difficulty of puncture due to spinal deformity;
- Prior neurological diseases.
Marcaine is not used during intravenous regional anesthesia (blockade of the Bier), because if bupivacaine is inadvertently entering the bloodstream, acute systemic toxic reactions may develop.
Relative contraindications (extra caution required):
- General serious condition;
- Heart block;
- Cardiovascular failure;
- Renal failure;
- Decreased hepatic blood flow (for example, in liver disease or chronic heart failure);
- Cholinesterase deficiency;
- Inflammatory diseases or infection of the injection site (if necessary, infiltration anesthesia);
- III trimester of pregnancy;
- Age over 65 years;
- Children's age up to 12 years;
- The need for paracervical anesthesia;
- The simultaneous appointment of antiarrhythmic drugs (including beta-blockers);
- The simultaneous use of other local anesthetics or drugs that are structurally similar to local amide-type anesthetics, such as antiarrhythmic drugs (for example, meksiletin or lidocaine).
Dosing and Administration
Specific doses depend on the type of anesthesia and the physical status of the patient.
The following doses are considered necessary for successful blockade, but should be considered as recommended for an average adult patient.
The average dose of Markain depending on the type of blockade and indications:
- Infiltration: surgery and postoperative analgesia - no more than 150 mg (or 30 ml of solution), begins to work after 1-10 minutes, the duration - 3-8 hours;
- Retrobulbar blockade: ophthalmosurgery - 10-20 mg (2-4 ml), begins to act after 5 minutes, duration - 4-8 hours;
- Peribulbar blockade: ophthalmosurgery - 30-50 mg (6-10 ml), takes effect after 10 minutes, duration - 4-8 hours;
- Intercostal blockade: pain relief in case of injury, surgery and postoperative analgesia - 10-15 mg (2-3 ml, per nerve), takes effect after 3-5 minutes, duration - 4-8 hours;
- Interpleural blockade: postoperative analgesia - 100 mg (20 ml), begins to act after 10-20 minutes, duration - 4-8 hours;
- Blockade of the brachial plexus (axillary supraclavicular, interlabular and subclavian perivascular): 150-200 or 100-150 mg (30-40 or 20-30 ml), takes effect after 15-30 minutes, duration - 4-8 hours;
- Blockade of the sciatic nerve: surgical interventions - 50-200 mg (10-35 ml), takes effect in 15-30 minutes, duration - 4-8 hours;
- Blockade of the femoral, obturator and lateral cutaneous nerve of the femur (3 in 1): surgical operations - 50-200 mg (10-35 ml), takes effect in 15-30 minutes, duration - 4-8 hours;
- Epidural block (at the lumbar level): labor anesthesia, postoperative pain relief and surgical interventions, including caesarean section - 75-150 mg (15-30 ml; dose takes into account the test test), takes effect after 15-30 minutes, duration - 2-3 hours;
- Epidural block (at the thoracic level): surgical interventions - 25-50 mg (5-10 ml; the dose takes into account the test test), takes effect after 10-15 minutes, duration - 2-3 hours;
- Caudal anesthesia: intraoperative and postoperative pain relief, as well as pain relief during diagnostic procedures and pain syndrome treatment - 100–150 mg (20–30 ml; the dose takes into account the test test), takes effect after 15–30 minutes, and takes 2–3 hours.
Markain should be administered carefully to prevent the development of acute toxic reactions due to accidental intravascular injection. Before and during the administration of the drug is recommended to carefully perform the aspiration test.
The main dose is administered at a rate of 25-50 ml / minute, or fractionally bolus, maintaining constant verbal contact with the patient.
In cases where a large dose is indicated (for example, during an epidural blockade), it is recommended to pre-administer the test dose: 3-5 ml of bupivacaine with adrenaline.
Children under 12 years of age determine the dose of Markain based on their weight. On average, it is up to 2 mg per kilogram of body weight, with lumbosacral blockade - 1.5-2 mg / kg of body weight, with thoracolumbular blockade - 1.5-2.5 mg / kg of body weight.
Epinephrine increases the duration of the blockade by 50-100%.
Adverse reactions of Markain are similar to those in the intrathecal administration of other local long-acting anesthetics. At the same time, side effects are difficult to distinguish from the physiological manifestations of nerve blockade (for example, such as temporary urinary retention, bradycardia, and hypotension), from reactions associated with the leakage of cerebrospinal fluid (for example, post-puncture headache) , spinal hematoma) or indirectly (for example, epidural abscess, meningitis) by needle insertion.
Possible side effects associated with marcaine:
- Very often (more than 1/10): hypotension, nausea;
- Often (more than 1/100, but less than 1/10): dizziness, paresthesia, high blood pressure, bradycardia, vomiting, urinary retention or incontinence;
- Less often (more than 1/1000, but less than 1/100): symptoms of toxicity from the central nervous and cardiovascular systems, such as visual disturbances, numbness of the tongue, noise and tinnitus, tremor, paresthesia, chills, loss of consciousness, headache, dysarthria, convulsions;
- Rarely (less than 1/1000): diplopia, unintentional total spinal block, neuropathy, paraplegia, arachnoiditis, paralysis, respiratory depression, allergic reactions, anaphylactic shock, cardiac arrest.
Local and regional anesthesia (with the exception of minor procedures) should be carried out by experienced medical specialists who have received appropriate training in anesthesia techniques and are familiar with the diagnosis and treatment of side effects of such drugs, in a room equipped accordingly, where necessary for cardiomonitoring and resuscitation measures are provided drugs and equipment.
If it is necessary to perform large blockades, it is recommended to install an intravenous catheter before introducing Markain.
When performing prolonged blockades by means of prolonged infusion or fractional administration of the drug, it is necessary to take into account the possibility of increasing the plasma concentration of the drug to toxic or the risk of local damage to the nerve fibers. Based on clinical experience, it can be concluded that the administration of 400 mg of bupivacaine to an adult patient within 24 hours is usually well tolerated.
In the event of signs of intoxication, the drug is immediately discontinued.
With the introduction of a large volume of solution containing adrenaline, you should consider the likelihood of developing systemic effects of adrenaline.
Bradycardia and hypotension may occur during epidural anesthesia. To reduce the risk of these complications can be, if you pre-enter the colloidal and crystalloid solutions. In the case of hypotension, it is necessary to immediately enter the sympathomimetic intravenously.
Marcaine does not contain preservatives, so it should be used immediately after opening the bottle. Remains of the solution can not be stored.
Bupivacaine should be used with caution at the same time as the following drugs: other local anesthetics, preparations similar in structure to local anesthetics of the amide type (antiarrhythmic drugs), as well as class III antiarrhythmic drugs.
Possible reactions of interaction of bupivacaine with other drugs:
- Tricyclic antidepressants, monoamine oxidase inhibitors - a pronounced increase in blood pressure;
- Drugs containing ergotamine or oxytocin - a steady increase in blood pressure with possible complications of the cerebrovascular and cardiovascular systems;
- General inhalation anesthesia with halothane is the risk of arrhythmia;
- Drugs that are structurally similar to local anesthetics - the risk of an additive toxic effect;
- Drugs that inhibit the central nervous system - enhancing the inhibitory effect.
When processing the place where Markaine will be injected with disinfectant solutions containing heavy metals, the risk of pain and edema increases.
At pH values above 6.5, the solubility of bupivacaine decreases. This must be taken into account when alkaline solutions are added, since precipitate formation is possible.
Terms and conditions of storage
Store at temperatures up to 25 ° C. Do not freeze. Keep out of the reach of children.
Shelf life - 3 years.