Spinal Anesthesia for c/section, what meds to substitute for 0.75%bupivacaine.

[anesthesia007]

Hi everyone, so we ran out of the 0.75% bupivacaine that we been using for c/sections, what is the substitute that you have used for spinal on c/section that is very comparative to the typical 0.75% bupivacaine? Thanks

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[Drwine]

0.5% isobaric bupivicaine can be used for spinals despite what the vial states "not for spinal anesthesia" which was a CYA for the company since a full bottle would be lethal. It is a lot of waste but will do the job. I would usually add narcotic and wait a little longer to let it set up before surgery.

 

[coffeebythelake]

Hi everyone, so we ran out of the 0.75% bupivacaine that we been using for c/sections, what is the substitute that you have used for spinal on c/section that is very comparative to the typical 0.75% bupivacaine? Thanks

With spinal anesthetic, the total dose and the baricity matters.
If you do 10 mg of 0.75% bupi then you can do a little more volume and administer 10 mg of 0.5% bupi.
Based on the shape of the spinal canal and the spread when laying down, an isobaric formulation isn't going to spread as much cephalad compared to hyperbaric. This might matter for your c-section if you are expecting a reliable T4 level.

 

[anesthesia007]

Thank you for that, so a 10 mg of a 0.5% bupivacaine is about 2 ml?

 

[anesthesia007]

0.5% isobaric bupivicaine can be used for spinals despite what the vial states "not for spinal anesthesia" which was a CYA for the company since a full bottle would be lethal. It is a lot of waste but will do the job. I would usually add narcotic and wait a little longer to let it set up before surgery.

Thanks, how many CC of the 0.5% bupivacaine do you typically use?

 

[NVO]

Thank you for that, so a 10 mg of a 0.5% bupivacaine is about 2 ml?

is this a serious question??

 

[sevo00]

Thank you for that, so a 10 mg of a 0.5% bupivacaine is about 2 ml?

lol yes. 0.5% means 5mg per ml. Are you a CA1?

 

[anesthesia007]

lol yes. 0.5% means 5mg per ml. Are you a CA1?

Yes sir 😊

 

[pgg]

Yes sir 😊

0.5% = 5 mg/mL
2% = 20 mg/mL

Move the decimal point one place to convert % to mg/mL concentration.


Also, in case you haven't connected the dots with 1:100,000 and 1:200,000 dilutions - divide the big number into 1,000,000 and that gives you mcg/mL.

So 1% lidocaine with 1:100,000 epi has 10 mg/mL of lidocaine and 10 mcg/mL of epinephrine.

The 10 mL code syringes with 1:10,000 epi are 100 mcg/mL, or 1000 mcg (1 mg) total.

These calcs should be second nature but I guess you don't know until someone tells you.

 

[anesthesia007]

Thank you for that, much appreciated Doc.

 

[DocVapor]

These calcs should be second nature but I guess you don't know until someone tells you.

/Start rant (not at you)

Both systems need to just go away as they're ridiculous. Should go to straight concentrations so that you can just look at a vial and know how much you're giving without needing to do the extra step.

/End rant

 

[pgg]

/Start rant (not at you)

Both systems need to just go away as they're ridiculous. Should go to straight concentrations so that you can just look at a vial and know how much you're giving without needing to do the extra step.

/End rant

Could be worse

At least we're not measuring stuff in grains any more.

 

[repititionition]

@anesthesia007 what country are you in?

 

[DrOwnage]

I hate it when nurses try to dilute bags from scratch with different epi concentrations in the OR. They always start saying the concentration out loud then usually look over towards the drapes for help as soon as 1:100,000 starts being muttered. I caught this one adding way more to a shoulder arthroscopy irrigation bag. I prefer pharmacy to handle that shiz, so easy for people to screw it up.

 

[anesthesia007]

@anesthesia007 what country are you in?

Hi I’m in America , sorry I ask such basic questions, like I mentioned I have always just use 0.75% bupivacaine and now we don’t have this mixture anymore and need to find another solution. Thanks you for all that responded and help me out and I learn from ppg post. I’m here to learn and ask questions. Thank you everyone who replied in s positive way I appreciated.

 

[skypilot]

Hi I’m in America , sorry I ask such basic questions, like I mentioned I have always just use 0.75% bupivacaine and now we don’t have this mixture anymore and need to find another solution. Thanks you for all that responded and help me out and I learn from ppg post. I’m here to learn and ask questions. Thank you everyone who replied in s positive way I appreciated.

Yes, as was stated above the 0.75% bupivicaine is 7.5 mg/ml. So you can figure out how many mg you used to give and continue to dose the same number of mg.

 

[Urzuz]

Hi I’m in America , sorry I ask such basic questions, like I mentioned I have always just use 0.75% bupivacaine and now we don’t have this mixture anymore and need to find another solution. Thanks you for all that responded and help me out and I learn from ppg post. I’m here to learn and ask questions. Thank you everyone who replied in s positive way I appreciated.

Dude as a CA1 you shouldn’t be concerned with finding an alternative to what you usually use for C sections. Ask your attendings what they want to use. Part of me believes you are an attending that is pretending to be a CA1 since you asked such a basic question and got called out lol

 

[sevo00]

Yeha if you’re a CA1 why aren’t you asking this question to your attendings lol.

 

[repititionition]

I have no problem answering questions for the sake of your patients’ safety, but between your syntax and the fact that you’re ostensibly making decisions like this as a CA-1... something still does not add up.

 

[pocafx]

Rural crna

 

[anesthesia007]

Wow, I ask a question to see what people use out there in the private practice or other institutions to get an idea, and all these comments of negative towards me.
Please admit close this thread, thank you for those that replied in a positive way, for those that have a negativity saying, may you think back when you were a ca1 and pause for a second. I know people can be cold and judgmental. I don’t think I’ll post again.

 

[Arch Guillotti]

Closing.