BUPIVACAINE

Local anaesthetic with long duration of action

Dosage Forms

Injection (with preservative)

0.5% (5 mg/ml)

Injection

0.5% (5 mg/ml)

Solution for injection

0.25% (Specialist use at RR)

Uses

  • Regional anaesthesia except intravenous regional anaesthesia

Dose and Duration

Regional anaesthesia
Adult and child over 12 years: see table below
Type of block Concentration (%) Dose (mg)
Local infiltration 0.25 max 150 (60 ml)
Peripheral nerve block 0.5 max 150 (30 ml)
Lumbar epidural block in surgery 0.5 50-100(10-20 ml)
Lumbar epidural block in labour 0.25-0.5 60 (12 ml)
Caudal block in surgery 0.25-0.5 max 150 (30 ml)
Caudal block in labour 0.25-0.5 max 100 (20 ml)

Contraindications

  • Inflamed or infected skin
  • Concomitant anticoagulant therapy
  • Severe anaemia or heart disease
  • Spinal or epidural anaesthesia in dehydrated or hypovolemic patients

Side Effects

  • Nausea, vomiting
  • NUrinary retention
  • Hypotension, bradycardia, cardiac arrest
  • Tingling or pricking sensation and dizziness
  • Respiratory depression
  • Allergic reaction, anaphylactic shock

Interactions

  • Propranolol (increased risk of bupivacaine toxicity)
  • Lidocaine( Increased myocardial depression)
  • Procainamide (Increased myocardial depression)

Pregnancy

  • Do not use in 1st trimester

Breastfeeding

  • Can be used

⚠️ Caution

  • Bupivacaine containing preservative should not be used for caudal, epidural or spinal block, or intravenous regional anaesthesia (Bier’s block)
  • Should not be applied to the middle ear due to risk of ototoxicity
  • ototoxicity  Use lower doses in the elderly and debilitated