Bupivacaine
MARCAINE
Pronunciation: byoo-PIV-a-kayn
What it isPeripheral sodium-channel-blocking amide anesthetic; regional and epidural anesthesia.
Why this oneIts duration outlasts lidocaine several-fold, and the liposomal form extends it further.
What limits it⚑ Inadvertent intravascular injection can cause refractory ventricular arrhythmia or arrest; lipid emulsion is the rescue treatment.
FDA-approved for
- local/regional anesthesia (1972)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Local or regional anesthesia/analgesia (surgery, oral surgery, diagnostic/therapeutic and obstetrical procedures) | Adults | Individualized by block type and concentration (0.25%, 0.5%, 0.75%) | Lowest effective dose | Individualized (see labeling); single dose usually sufficient |
Renal Substantially excreted by the kidney; greater risk of adverse reactions in renal impairment
Hepatic Reduced dosing and increased monitoring for systemic toxicity in moderate to severe hepatic impairment (impaired metabolism), especially with repeat doses
Repeated doses may cause significant cumulative increases in plasma levels; allow adequate spacing
Instructions
- Aspirate for blood/CSF before and during injection; use incremental (fractional) doses
- Not for intrathecal use
- Avoid preservative-containing (multidose) vials for epidural/caudal anesthesia
- Monitor cardiovascular/respiratory vital signs and consciousness after each injection
- Reduce dose in debilitated, elderly, or acutely ill patients
Available strengths
- inj 2.5, 5, 7.5, 13.3 mg/mL
Contraindications
- Obstetrical paracervical block anesthesia (has caused fetal bradycardia and death)
- Intravenous regional anesthesia (Bier block)
Cautions
- Cardiac arrest in obstetrical anesthesia (0.75%)
- Dose-related/local anesthetic systemic toxicity
- Methemoglobinemia
- Chondrolysis with intra-articular infusion
Adverse reactions
- CNS: restlessness, anxiety, dizziness, tremors, convulsions, drowsiness
- Cardiovascular: hypotension, bradycardia
- Methemoglobinemia
Pregnancy Contraindicated for obstetrical paracervical block; no adequate human data; local anesthetics rapidly cross the placenta and can cause maternal/fetal/neonatal toxicity.
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 2.5 mg/mL | inj | per unit | $0.05/mL | not offered |
| 5 mg/mL | inj | per unit | $0.09/mL | not offered |
| 7.5 mg/mL | inj | per unit | not offered | |
| 13.3 mg/mL | inj | per unit | not offered |
Generic entry1986
⚠ BOXED WARNING
- The 0.75% concentration is not for obstetric anesthesia; cardiac arrest has occurred
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityLocal tissue injury and inadvertent systemic exposure can cause seizures or cardiovascular toxicity.