for spinal (subarachnoid) anaesthesia.

Local Anesthetic
Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction

Onset of action:
1. Epidural: Up to 17 minutes to spread to T6 dermatome.
2. Spinal: Within 1 minute; maximum dermatome level achieved within 15 minutes in most cases.
Duration:
1. Epidural: 2 to 7.7 hours.
2. Spinal: 1.5 to 2.5 hours.
Distribution:
1. Vd: (Infants) 3.9 L/kg; (Children) 2.7 L/kg.
2. Protein binding: 84% to 95%.
Metabolism:
Hepatic; forms metabolite
Time to peak, plasma:
30 to 45 minutes
Excretion:
Urine (~6% unchanged); Clearance: (Infants) 7.1 mL/kg/minute; Children: 10 mL/kg/minute.

1. Hypersensitivity to bupivacaine hydrochloride, amide-type local anesthetics, or any component of the formulation
2. Obstetrical paracervical block anesthesia
3. IV regional anesthesia

Compatible with breastfeeding (WHO); Infant risk is minimal (MDX)

Hypotension, bradycardia, nausea, postdural puncture headache, vomiting, urinary retention, urinary incontinence

1. There are no specific dosage adjustments provided in the manufacturer's labeling.
2. Risk of adverse reactions may be increased in patients with renal impairment, particularly in patients with severe kidney disease. Consider increased monitoring for toxicities.

1.There are no specific dosage adjustments provided in the manufacturer's labeling.