Bupivacaine is a long-acting local anaesthetic used to numb parts of the body during surgery and childbirth: spinal anaesthesia, nerve blocks and infiltrations. The effect lasts 3–8 hours, much longer than lidocaine.
Also known as: Marcaina, Bupivacaina HCl
DailyMed/FDA approved label — Bupivacaine Hydrochloride (see combination labels: Physicians EZ Use M-PRED validates via CYP; prefer mono-ingredient label): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=76b15f6a-51d6-45ec-b6cb-8b10a08ed32a — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
No documented drug–drug interactions for this medicine.
No documented food or drink interactions.
Bupivacaine depresses cardiac conduction — contraindicated in AV block and sick sinus syndrome (regional/IV use).
ECG in regional anaesthesia; mandatory monitoring.
Site monograph (bupivacaine — 2nd/3rd-degree AV block); EMC-UK bupivacaine SmPC 4.3.
Systemic bupivacaine toxicity causes seizures and severe arrhythmias (maximum cardiotoxicity among local anaesthetics).
Respect maximum dose; aspirate before injecting; lipid 20% available.
Site monograph (bupivacaine — maximum dose by weight, aspirate before injecting).
No specific Annex 1 entry; bupivacaine is the reference local anaesthetic for epidural and subarachnoid analgesia/anaesthesia in labour and caesarean section, with long fetal safety experience. Known risk: serious cardiotoxicity on accidental intravascular injection — aspiration technique and test dose are mandatory; the 0.75% formulation is contraindicated in obstetrics (label).
Compatible for obstetric regional anaesthesia (epidural/subarachnoid) at usual obstetric concentrations; never IV; do not use 0.75% in obstetrics.
Compatible — little passes into milk (high plasma protein binding).
EMC-UK (MHRA) — Bupivacaine SmPC (Marcain): https://www.medicines.org.uk/emc/product/2951/smpc (sections 4.3, 4.6).
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Sensory (and motor at high concentration) block with onset in 5–10 min and 3–8 h duration.
Voltage-gated sodium channel block (preference for the inactivated state); slow dissociation during cardiac diastole explains relative cardiotoxicity.
Local infiltration: absorption dependent on vascularity; adrenaline reduces plasma peak by 30–50%.
Hepatic hydroxylation (CYP3A4) to inactive metabolites; renal excretion.
~ 3.5 h (adult; neonate up to 8–12 h).
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
