Markain

Marcain is a local anesthetic with long-lasting medicinal effect. Its effect is four times stronger than that of lidocaine.

Indications of the markina

It is used in such situations:

• at various traumas or an arthroscopy, and besides it for infiltrative anesthesia (after surgical operations);
• to help with childbirth, and in addition to the procedure of cesarean section;
• when intercostal blockade occurs or when blockade occurs in the area of large nerves;
• with a retrobulbar form of anesthesia.

Use of Drug Form Marcain Spinal: to perform spinal anesthesia for the duration of operations in the urological area, and also in the peritoneum or on the legs.

[1], [2], [3]

Release form

The release occurs in the form of an injectable medical solution (0.25% or 0.5%) in flasks with a volume of 20 ml.

Markain Spinal - a sterile form of a solution on water of bupivacaine (volume 5 mg / ml). Due to the addition of sodium chloride in it, the solution becomes isotonic. The effect of the drug is quite strong and starts quickly enough. Demonstrates a fairly long-lasting effect.

Markain Spinal Heavy  is also a solution of bupivacaine with a volume of 5 mg / ml, but there is no sodium chloride, instead of which there is a dextrose solution that gives the drug hyperbaric properties. It acts more intensively than Markain Spinal, but, since it has a larger spreading area, has a lower concentration at the site of injection, which also decreases the duration of its effect.

Pharmacodynamics

The drug is a reversible blocker of pulses passing through the nerve endings. It acts by suppressing the passage of sodium through the cell walls.

Has antihypertensive properties. During the blockade of peripheral nerves, the duration of the anesthetic effect is 12 hours, with epidural analgesia within 2-5 hours, and with intercostal blockage within 7-13 hours.

The substance is manufactured in 2 concentrations: 5 or 2.5 mg / ml (the effect of the latter is weaker). In small dosages it does not have a pronounced effect and is used during childbirth, and also after surgical procedures.

[4],

Pharmacokinetics

The rate of absorption of the drug depends on the size of the dosage and the method of administration of the solution. Peak values are observed during the treatment of intercostal blockades, and the lowest values are in case of injection of the drug in an abdominal fashion.

In the epidural region, the absorption of the substance passes in 2 phases. The half-life in this case is 6 hours. With iv injection, this segment lasts 2.5 hours. In a newborn child, the half-life is longer than for an adult - about 7-8 hours.

Demonstrates high level of protein synthesis. Completely exposed to metabolic processes inside the body.

[5], [6]

Dosing and administration

Any procedure of anesthesia can be performed only by a doctor, he also chooses the size of dosages. Do not administer more than 2 mg / kg of the drug. The adult portion is usually 30 ml.

During the infiltration anesthesia, 5-30 ml of the drug is administered.

In the case of blockade in the intercostal nerve - it is necessary to inject 2-3 ml of solution per nerve.

When blockade in the area of large nerves (with pain in the sacral area or in the brachial plexus area), an injection of 15-30 ml LS is required.

Caudal anesthesia during labor - the dose is 6-10 ml of solution. When performing the procedure of anesthesia, it is necessary to closely monitor blood pressure.

Use of the markina during pregnancy

If Marcian is used to perform paracervical type in a pregnant blockade, the rhythm of the heartbeat in the fetus may develop, which is why after the introduction of drugs it is necessary to constantly monitor the heart rate and heart rate in the fetus.

Women in the 3rd trimester are required to change the dosage of the drug in the form of Spinal Heavy.

The active element of the medicine passes into the mother's milk, but the probability of negative reactions in the nursing baby is extremely low because of this.

Contraindications

The main contraindications:

• the presence of hypersensitivity to the drug;
• childhood;
• decreased blood pressure.

For the form of medicine Spinal Heavy:

• pathology in the central nervous system (bleeding, meningitis, brain tumors and poliomyelitis);
• diseases in the spine, which are in their active phase;
• spine injury;
• problems with the clotting system;
• presence of anemia;
• skin diseases at the site of the puncture;
• shock state of cardiogenic type.

Both forms of the drug should be carefully prescribed to the elderly, and in addition, if the patient has arrhythmia, AV blockade, diseases in the CCC, multiple sclerosis, and besides hemiplegia.

[7], [8], [9], [10], [11]

Side effects of the markina

The use of the solution can provoke the appearance of such adverse reactions:

• decreased blood pressure;
• the development of bradycardia, a disorder of the heart rhythm, and at the same time the arrest of cardiac activity;
• numbness of the tongue and the appearance of paresthesias;
• the occurrence of ear noise or dizziness;
• the appearance of seizures or tremors;
• injuries in the peripheral nerves;
• the appearance of anaphylaxis, skin manifestations, suppression of respiratory processes;
• problems with urination;
• can begin to double in the eyes;
• the appearance of pain in the back, and in addition a complete blockade of the spinal type (when using the form of drugs - Spinal Heavy).

[12]

Overdose

Poisoning is expressed in the form of toxic manifestations from the CCC and CNS. Similar reactions occur in the case of a random intravascular injection. Among the symptoms of an overdose are dizziness with paresthesia, ear noise, weakening of vision and numbness of the tongue. Then there are convulsions with tremors, an attack of epilepsy and loss of consciousness. The condition of the victim will improve if the solution is stopped. Signs of a violation in the field of CAS organs appear later, and arise in the form of blockades, lowering the indices of BP and bradycardia.

It is required to maintain the work of respiratory organs and blood flow, provide oxygenation or perform artificial respiration if the situation is severe. If the victim has convulsions - he is injected with sodium thiopental.

[13], [14]

Interactions with other drugs

When combined with antiarrhythmic drugs and other anesthetics (for example, with mexiletine or lidocaine), the likelihood of developing toxic effects increases.

Combination with halothane anesthetic potentiates the likelihood of arrhythmias.

MAOI, which is used in combination with Markain, increases the risk of increased blood pressure.

It is forbidden to mix the medicinal solution with other medications.

[15], [16], [17], [18], [19]

Storage conditions

Markain is contained in standard for medicines conditions. Temperature marks are in the range of 15-25 ° C.

[20],

Special instructions

Reviews

Markain contains bupivacaine, which is a powerful anesthetic, 16 times more effective than novocain. The anesthetic effect begins later (in comparison with lidocaine), but is more prolonged - taking into account the size of the dosage and the method of administration, it can last within 3-12 hours. The index of muscle relaxation in this drug, according to reviews, is higher than that of lidocaine.

Spinal forms of drugs demonstrate higher safety and efficacy as an analgesic. The main advantage of the drug is the lack of necessity in combination with analgesic drugs, as well as in additional prolongation. In addition, there is no need to reduce the dose due to the possible toxic properties of drugs. These forms of medication are used for any operations in the gynecological area, with amputations, cesarean sections, hernias, and adenomectomies. Medical practice shows that the hyperbaric type of medication is more optimal than isobaric, because it is easier to manage. But in this case, patients note that when performing an anesthetic of the spinal type, often negative effects develop.

Usually during the application of hyperbaric anesthesia, the development of bradycardia occurs already at the postoperative stage, but in the case of using Markain Spinal this effect is observed much earlier - even at the stage of the operation.

[21]

Shelf life

Marcaine is allowed to be used for 3 years from the date of release of the drug.

[22], [23]