Additive toxic effects with other  local anesthetics

Additive cardiac effects possible with concomittant Class III  antiarrhythmics eg. amiodarone
Consider ECG monitoring

May be potentiated by CYP1A2 inhibitors (eg fluvoxamine, theophylline, imipramine ) and
potent CYP3A4  inhibitors ( eg.ketoconazole )

Incompatible with alkaline solutions

Acute pain management

Epidural Block-
Local or regional anesthesia for surgery ( epidural block including cesarian section, major nerve block,
local infiltration )
 

Hypotension
GI upset, bradycardia (maternal and foetal)

Fever, pain, urinary retention , seizures, pruritus, foetal distress, anemia, jaundice,

Paraesthesia, headache, back or chest pain, syncope,  dyspnoea, insomnia,

Cardiac arrest, oliguria, headache, dizziness, anxiety

IV administration- (unintended IV injury may result in cardiac arrrest esp. in elderly and in patients
with concomittant heart disease)

Local inflammation, sepsis, septicaemia.
Obsteritics para-cervical block. Biers block.

Special Precautions-
Keep resuctive equipment available, prolonged resucitative efforts may be required.

Have protocol for mailgnant hyperthermi management available

Impaired  cardiovascular and respiratory functions

Hypotension. Decreased plasma proteins,

Hypovaolemia, Hyperkalemia.
 
Heart block,   Acute Porphyria

Hepatic or  renal impairment,  acidosis,

Labor and delivery- monitor heart rate.

Elderly, Pregnancy and lactation

Indication-

Acute pain management
Epidural Block-
Local or regional anesthesia for surgery ( epidural block including cesarian section, major nerve block,
local infiltration )

Dosage-
Avoid rapid administration of large administration of local anesthestic solution
and use fractional ( incremental ) doses.
Administer the smallest dose required to produce the desired effect.

Test dose- use an adequate test dose ( 3 to 5ml ) of a short acting local anesthetic
containing epinephrine ) prior to induction of complete block.
Repeat this test dose if patient movement potentiates epidural catheter displacement
Allow adequate time for onset of anesthesia following adminstration of each test dose.

Observe caution if required to be used during pregnancy and or while administering to breast feeding
mothers