"Not for Caudal, Epidural, Or Spinal Anesthesia"

[ethilo]

Just wondering, what's the reason why bupi 0.25 % with epi 1:200k has "Not for Caudal, Epidural, Or Spinal Anesthesia" written on the vial?

From what I remember, I was told in residency it's because it just doesn't have FDA approval but could be used "off label" as you consider risks of added risk of neurotoxicity from epi. However I've found "for nerve block only, not for caudal, epidural, or spinal use" on plain Bupi vials as well so I'm not sure. I did some google searches and came up with nothing.

It does "contain sulfites," is that what the issue is? Needs to be preservative free?

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[IMGASMD]

Pretty sure I didn’t answer anything on the first go.

 

[deleted162650]

It does "contain sulfites," is that what the issue is? Needs to be preservative free?

Yes.

 

[kmurp]

I keep local anesthesia drugs with preservatives off of our block cart to avoid an accidental mistake.

 

[dannyboy1]

I was told because it’s slightly hypobaric so there is a theoretical risk of high spinal. Also not FDA approved. It is widely used though. I did have a colleague that always documented using the .75 bupiv (weather it was used or not).....

 

[drmwvr]

There are preparations of bupivicaine,

I was told because it’s slightly hypobaric so there is a theoretical risk of high spinal. Also not FDA approved. It is widely used though. I did have a colleague that always documented using the .75 bupiv (weather it was used or not).....

the "not for spinal, epidural, etc." warning because of preservative additives is not the same as the "not for spinal" warning. Yes, agents like .5 marcaine or 3% chloroprocaine or 2% lidocaine (all PF preparations) are hypobaric but they're used off label for SAB because they perform differently than the hyperbaric preparation in the kits. They require a larger volume of medicine but "fix" basically at the level they're placed. They also last longer than the hyperbaric prep but not as long as if you added epi to the hyperbaric. They split the difference and so give the ability to better time a spinal for longer procedures and/or immediate post op analgesia. And for really short spinal cases like cervical cerclage, the 3- chloroprocaine isobaric (for "epidural use only") really has no equal.

BTW...Why would anyone falsify a medical record for a legitimate off label use of a drug?

 

[deleted875186]

Just wondering, what's the reason why bupi 0.25 % with epi 1:200k has "Not for Caudal, Epidural, Or Spinal Anesthesia" written on the vial?

From what I remember, I was told in residency it's because it just doesn't have FDA approval but could be used "off label" as you consider risks of added risk of neurotoxicity from epi. However I've found "for nerve block only, not for caudal, epidural, or spinal use" on plain Bupi vials as well so I'm not sure. I did some google searches and came up with nothing.

It does "contain sulfites," is that what the issue is? Needs to be preservative free?

I believe the epi containing locals typically have preservatives.

The plain bupIvicaine 0.5% and chloroprocaine 3% are preservative free and as pointed out can be used for spinals. Whoever makes them never got FDA approval for spinal anesthesia so it says not for spinal on the front.

I believe a company just got FDA approved for chloroprocaine for spinal, and now sells it Marketed as such.

 

[KENY1]

B. Braun Will Launch its First Spinal Anesthetic at ASRA: Reimagining Anesthesia

B. Braun Medical Inc. will introduce its first FDA-approved local anesthetic for spinal anesthesia -- Clorotekal® (chloroprocaine hydrochloride) -- at the American Society of Regional Anesthesia (ASRA) and Acute Pain Medicine’s 43rd annual conference from April 19-21 in New York City. B. Braun...

www.bbraunusa.com

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[rightonn_dude]

I was told 0.5% PF Bupi was also “not for spinal” use cause of its size. I’ve only seen it and 25 to 30ml vials. An amount which would ever be used.

 

[Planktonmd]

The not for spinal one is because of the volume of the vial and nothing else. The ones that say not for spinal or epidural have preservatives and should not even be used for nerve blocks.

 

[ethilo]

I was told 0.5% PF Bupi was also “not for spinal” use cause of its size. I’ve only seen it and 25 to 30ml vials. An amount which would ever be used.

We have bupi 0.5% plain in 10 mL vials, just fyi these exist.