Generic
Bupivacaine
6 brands available in the market
At a glance
Bupivacaine is a local anesthetic used in dental, surgical, diagnostic, and therapeutic procedures to anesthetize or numb the surgical area. It is also used for pain relief during labor. It blocks nerve impulses that send pain signals to the brain, providing temporary numbness.
Description
Bupivacaine is a prescription medication used as a local anesthetic for dental, oral, diagnostic, and other therapeutic procedures. It is also effective for pain relief, such as during labor.
Bupivacaine blocks both the initiation and conduction of nerve impulses by reducing the permeability of neuronal membranes to Na⁺ ions, resulting in inhibition of depolarization and blockade of conduction. It temporarily numbs the surgical area by blocking pain signals to the brain.
Indications
- Local anesthesia (numb tissues in a specific area)
- Dental surgery
- Surgical procedures
- Labor pain (obstetrical analgesia)
- Peripheral and sympathetic nerve block
- Epidural and spinal block
Therapeutic class
Local Anesthetic
Pharmacological class
Amide-type Local Anesthetic
Pharmacology
Bupivacaine is an amide-type local anesthetic that works by blocking sodium channels in neuronal cell membranes. It reduces the permeability of neuronal membranes to Na⁺ ions, inhibiting depolarization and blocking both the initiation and conduction of nerve impulses. This action is reversible, and nerve function resumes after the drug effect wears off.
Mechanism of action
Bupivacaine blocks sodium channels in nerve cell membranes, preventing Na⁺ ion influx, which inhibits depolarization and prevents pain signals from reaching the brain.
Dosage
Adults (Injection):
Percutaneous infiltration anesthesia: 9 mg (with adrenaline 1:200,000), repeat after 2-10 minutes if needed. Max: 90 mg per dental sitting.
Peripheral nerve block: 12.5 mg (0.25% solution) or 25 mg (0.5% solution). Max: 150 mg/dose.
Sympathetic nerve block: 0.25% solution: 50-125 mg.
Retrobulbar block: 0.75% solution: 15-30 mg.
Caudal block (surgery): 0.25% solution: 37.5-75 mg; 0.5% solution: 75-150 mg.
Lumbar epidural block (surgery): 0.25% solution: 25-50 mg; 0.5% solution: 50-100 mg.
Spinal block: 0.5% solution: 10-20 mg (2-4 mL).
Acute pain (labor pain): 0.25% solution: 15-30 mg (6-12 mL); 0.375%: 22.5-45 mg; 0.5%: 30-60 mg. Infusion: 0.1%: 10-15 mg/hr; 0.125%: 10-15 mg/hr.
Children (>12 years): Infiltration: 0.25% locally; max 175 mg. Caudal block: 15-30 mL of 0.25% or 0.5% (preservative-free). Epidural block: 10-20 mL of 0.25% or 0.5%. Peripheral nerve block: 5 mL of 0.25-0.5%; max 400 mg/day.
Administration
Administered by healthcare professional as an injection. Patient should not self-administer.
Missed dose
Hospital-only medicine. Administered by doctor or nurse. Patient should not self-administer. If you miss a dose, consult your doctor.
Side effects
Common side effects:
Nausea, paresthesia (tingling or pricking sensation), slow heart rate (bradycardia), decreased blood pressure, dizziness, urinary retention, increased blood pressure, vomiting.
Effects typically last 2-4 hours.
Precautions & warnings
- Numbness may last 2-4 hours after injection. Do not drive or operate machinery until the effect wears off.
- May affect concentration or cause sleepiness; avoid driving or using tools/machines until the next day.
- Consult your doctor immediately if you experience dizziness, lightheadedness, vision/hearing problems, or numbness around lips, tongue, and mouth.
- Inform your doctor if you are pregnant, planning pregnancy, or breastfeeding.
- Inform your doctor about any underlying heart disease or heart rhythm problems.
- Caution in patients with liver and kidney disease.
Contraindications
- Hypersensitivity to amide-type local anesthetics
- IV regional anesthesia
- Paracervical block in obstetrics
- Spinal anesthesia in patients <18 years
- Lactation
- Solutions containing preservatives for caudal or epidural block
Drug interactions
- Other local anesthetics or agents structurally related to amide-type (lidocaine, mexiletine): Additive systemic toxic effect.
- Antiarrhythmic drugs: Increased risk of myocardial depression.
- Hyaluronidase: Enhanced adverse effects.
- Cimetidine and ranitidine: Decreased clearance and increased plasma concentrations.
- Beta-blockers and calcium channel blockers: Increased risk of adverse effects.
Food interactions
It is not known whether it is safe to consume alcohol with Bupivacaine. Please consult your doctor.
Use in pregnancy
May be unsafe during pregnancy (Category C). Limited human studies available; animal studies have shown harmful effects on the developing baby. Your doctor will weigh benefits and risks before prescribing.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Probably safe during breastfeeding (if prescribed). Limited human data suggests the drug does not pose significant risk to the baby.
Pediatric use
Geriatric use
No specific dose adjustment required for elderly, but caution advised.
Renal / hepatic impairment
Hepatic impairment: Use with caution; dose adjustment may be needed.
Overdose effects
Overdose symptoms: Dizziness, tinnitus, blurred vision, tremors, seizures, cardiac arrest, respiratory distress. Consult your doctor immediately if overdose is suspected.
Storage conditions
Store below 25°C, away from light and moisture. Keep out of reach of children.
Chemical structure
Bupivacaine Hydrochloride (Amide-type Local Anesthetic)