“Heavy Bupi” aka Hyperbaric Bupivacaine

“Heavy Bupi”
Otherwise known as hyperbaric bupivacaine, this is the medication that we give through a spinal injection that has potential to provide surgical anesthesia from your chest and down to your toes. We use this type of anesthesia commonly for hip and knee replacements, as well as for cesarean sections. You can use isobaric or hyperbaric local anesthetics in your spinal, but the bupivacaine solution in the kits that we use are hyperbaric. Let’s go over some definitions:
Baricity - another word for density. Hyperbaric means that the solution is denser than the cerebral spinal fluid (CSF). This means that the medicine will sink in the CSF fluid within the spinal sac. The added dextrose (usually 5-8%) will increase the density of the solution. This is why we lay the patient down quickly after performing a spinal with hyperbaric bupivacaine. Otherwise it would settle around the sacral nerve roots providing the associated dermatomal blockade (saddle block). We can also place the patient in Trendelenburg (head down) position to have the medicine travel up the spinal sac to increase the level of the blockade.
Dermatomes - these are areas of your body that are given sensation by a specific level of the spinal cord. These levels run in parallel (for the most part) with the head receiving sensation from the cervical spine and the legs receiving sensation from the lumbar spine. Testing the patient’s body based on these landmarks with either a sharp or cold object will help you determine the level of your spinal blockade since it is associated with a specific spinal root level.
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