From: Samantha Rustamov
To: Pharmacists
Cc: Tiffany Ashley, Cedrick Byrd, Marie Kellum, Chad Hartley, Anya C. Holowczak
Sent: Monday, March 12, 2018 4:16:26 PM
Subject: Hyperbaric Marcaine for Spinal Anesthesia

Good afternoon,

Please see the e-mail below that was sent to the Anesthesia Department regarding pharmacy's plan for dealing with the shortage of Marcaine Spinal. Should you receive a call from the OR requesting it for a non- cesarean section case (i.e. orthopedics), reasonable alternatives at this time include bupivacaine -pf 0.25% and 0.5% w/o dextrose. Please feel free to contact me with any questions.

Thanks!


Spinal trays containing hyperbaric bupivacaine (Marcaine Spinal) are not available due to drug shortage, and pharmacy is unable get any/enough bupivacaine to supply the OR. After much debate, we are going to supply OR areas, for C-section only, the "equivalent" of Marcaine Spinal.

Marcaine Spinal vials contain: bupivacaine 0.75% and dextrose 8.25% in 2 mL
 
To mirror this as best we can, pharmacy will prepare two separate syringes:
 
    * bupivacaine-pf 0.75% 2 mL
    * dextrose 50% 0.3 mL

*Note the "equivalent" does not contain a buffer; which is added to the commercial vial

 

The two syringes will be packaged together and loaded into the appropriate Pyxis device as "bupivacaine 0.75% 2 mL + dextrose 50% 0.3 mL kit". Syringe kits will ONLY be loaded in L&D OR 3 at HHWC, and OR 4 A-system Pyxis at Madison Hospital.

Shelf-life will be 30 hours for both HHWC and Madison Hospital.

Let me know if you have any questions.

Samantha Rustamov, Pharm.D., BCPS
Supervisor, Pharmacy Professional Services Huntsville Hospital Department of Pharmacy