Vopicain Warnings

In performing Vopicain blocks, unintended intravenous injection is possible and may result in cardiac arrest. Despite rapid detection and appropriate treatment, prolonged resuscitation may be required. The resuscitability relative to bupivacaine is unknown at this point in time as it has not been studied. As with all local anesthetics of the amide type, Vopicain should be administered in incremental doses. Since Vopicain should not be injected rapidly in large doses, it is not recommended for emergency situations, where a fast onset of surgical anesthesia is necessary.
Historically, pregnant patients were reported to have a high risk for cardiac/circulatory arrest, and death when bupivacaine was inadvertently rapidly injected intravenously. Avoid 0.75% Vopicain in obstetrical patients. This concentration is indicated only for non-obstetrical surgery requiring profound muscle relaxation and long duration. For cesarean section, the 5 mg/mL (0.5%) Vopicain solution in doses up to 150 mg is recommended.
Local anesthetics should only be administered by clinicians who are well versed in the diagnosis and management of drug-related toxicity and other acute emergencies which might arise from the block being administered. The immediate availability of oxygen, other resuscitative drugs, cardiopulmonary resuscitative equipment, and the personnel resourcer needed for proper management of toxic reaction and related emergencies must be ensured (see Adverse Reactions and Precautions). Delay in proper management of drug-related toxicity, underventilation from any cause, and/or altered sensitivity may lead to the development of acidosis, cardiac arrest, and possibly death.
Solutions of Vopicain should not be used for the production of obstetrical paracervical block anesthesia. There are no data to support such use and there is the additional risk of fetal bradycardia and death.
Intravenous regional anesthesia (Bier Block) should not be performed using Vopicain because of the lack of clinical experience and the risk of attaining toxic blood levels of levobupivacaine.
It is essential that aspiration for blood or cerebrospinal fluid (where applicable), be done prior to injecting any local anesthetic, both before the original dose and all subsequent doses, to avoid intravascular or intrathecal injection. However, a negative aspiration does not ensure against intravascular or intrathecal injection. Vopicain should be used with caution in patients receiving other local anesthetics or agents structurally related to amide-type local anesthetics, since the toxic effects of these drugs are additive.
When contemplating a peripheral nerve block, where large volumes of local anesthetic are needed, caution should be exercised when using the higher mg/mL concentrations of Vopicain. Animal studies demonstrate CNS and cardiac toxicity that is dose related, thus equal volumes of higher concentration will be more likely to produce cardiac toxicity.