Drug reference

Bupivacaine hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1441, 1442

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Surgical anaesthesia, lumbar epidural block ▶BY REGIONAL ADMINISTRATION ▶Adult: 75–150 mg, dose administered using a 5 mg/mL (0.5%) solution Surgical anaesthesia, field block ▶BY REGIONAL ADMINISTRATION ▶Adult: Up to 150 mg, dose administered using a 2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution Surgical anaesthesia, thoracic epidural block ▶BY THORACIC EPIDURAL ▶Adult: 12.5–50 mg, dose administered using a 2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution Surgical anaesthesia, caudal epidural block ▶BY REGIONAL ADMINISTRATION ▶Adult: 50–150 mg, dose administered using a 2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution Surgical anaesthesia, major nerve block ▶BY REGIONAL ADMINISTRATION ▶Adult: 50–175 mg, dose administered using 5 mg/mL (0.5%) solution Acute pain, intra-articular block ▶BY INTRA-ARTICULAR INJECTION ▶Adult: Up to 100 mg, dose administered using a 2.5 mg/mL (0.25%) solution; when co-administered with bupivacaine by another route, total max. 150 mg Acute pain, thoracic epidural block ▶BY CONTINUOUS EPIDURAL INFUSION ▶Adult: 6.3–18.8 mg/hour, dose administered using a 1.25 mg/mL (0.125%) or 2.5 mg/mL (0.25%) solution; maximum 400 mg per day Acute pain, labour ▶BY CONTINUOUS EPIDURAL INFUSION ▶Adult: 6.25–12.5 mg/hour, dose administered using a 1.25 mg/mL (0.125%) solution; maximum 400 mg per day Acute pain, lumbar epidural block ▶INITIALLY BY LUMBAR EPIDURAL ▶Adult: 15–37.5 mg, then (by lumbar epidural) continued → 15–37.5 mg, repeated when required at intervals of at least 30 minutes, dose administered by intermittent injection using a 2.5 mg/mL (0.25%) solution, alternatively (by continuous epidural infusion) 12.5–18.8 mg/hour, dose administered using a 1.25 mg/mL (0.125%) or 2.5 mg/mL (0.25%) solution; maximum 400 mg per day Acute pain, field block ▶BY REGIONAL ADMINISTRATION ▶Adult: Up to 150 mg, dose administered using a 2.5 mg/mL (0.25%) solution DOSES AT EXTREMES OF BODY-WEIGHT ▶To avoid excessive dosage in obese patients, dose should be calculated on the basis of ideal body-weight. MARCAIN HEAVY ® Intrathecal anaesthesia for surgery ▶BY INTRATHECAL INJECTION ▶Adult: 10–20 mg

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Contra Indications

Avoid injection into infected tissues . avoid injection into inﬂamed tissues. intravenous regional anaesthesia (Bier’s block). preparations containing preservatives should not be used for caudal, epidural, or spinal block CONTRA-INDICATIONS, FURTHER INFORMATION ▶Injection site Manufacturer advises local anaesthetics should not be injected into inﬂamed or infected tissues. Increased absorption into the blood increases the possibility of systemic side-effects, and the local anaesthetic effect may also be reduced by altered local pH.

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Cautions

Cardiovascular disease. cerebral atheroma. complete heart block. debilitated patients (consider dose reduction). elderly (consider dose reduction). epilepsy. hypertension. hypotension. hypovolaemia. impaired cardiac conduction. impaired respiratory function. myasthenia gravis. myocardial depression may be more severe and more resistant to treatment. shock

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Allergy And Cross Sensitivity

▶Hypersensitivity and cross-sensitivity Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as tetracaine; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be avoided by using the alternative chemical type.

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Safety

Important Safety Information

The licensed doses stated may not be appropriate in some settings and expert advice should be sought. Anaesthesia Should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and should not be administered parenterally unless adequate resuscitation equipment is available.

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Interactions

→Appendix 1: anaesthetics, local

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Side Effects

▶Common or very common Arrhythmias. dizziness. hypertension. hypotension. nausea. paraesthesia. urinary retention. vomiting ▶Uncommon Neurotoxicity ▶Rare or very rare Arachnoiditis. cardiac arrest. diplopia. nerve disorders. paraplegia. paresis. respiratory depression SIDE-EFFECTS, FURTHER INFORMATION Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection. The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. The onset of toxicity can be unpredictable and delayed. Monitor as per local protocol for at least 30 minutes after administration.

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Pregnancy

Large doses during delivery can cause neonatal respiratory depression, hypotonia, and bradycardia after epidural block. Dose adjustments Use lower doses for intrathecal use during late pregnancy.

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Breast Feeding

Amount too small to be harmful.

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Hepatic Impairment

Manufacturer advises use with caution in advanced liver dysfunction.

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Renal Impairment

Use with caution in severe impairment.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: solution for injection, infusion, solution for infusion Solution for injection ▶Bupivacaine hydrochloride (Non-proprietary) Bupivacaine hydrochloride 2.5 mg per 1 ml Bupivacaine 25mg/10ml (0.25%) solution for injection vials | 10 vial P s Bupivacaine 0.25% solution for injection 10ml Sure-Amp ampoules | 20 ampoule P £17.50 DT = £17.50 Bupivacaine hydrochloride 5 mg per 1 ml Bupivacaine 0.5% solution for injection 10ml Sure-Amp ampoules | 20 ampoule P £18.30 DT = £18.30 Bupivacaine 100mg/20ml (0.5%) solution for injection vials | 10 vial P s Bupivacaine 50mg/10ml (0.5%) solution for injection ampoules | 10 ampoule P £7.56 DT = £7.56 | 10 ampoule P £17.58 DT = £7.56 (Hospital only) Bupivacaine hydrochloride anhydrous 40 mg per 1 ml Bupivacain Sintetica 40mg/ml (4%) solution for injection ampoules | 10 ampoule P s ▶Marcain (Aspen Pharma Trading Ltd) Bupivacaine hydrochloride 2.5 mg per 1 ml Marcain 0.25% solution for injection 10ml Polyamp Steripack ampoules | 5 ampoule P £7.92 DT = £7.92 (Hospital only) Bupivacaine hydrochloride 5 mg per 1 ml Marcain 0.5% solution for injection 10ml Polyamp Steripack ampoules | 5 ampoule P £9.25 DT = £9.25 (Hospital only) Infusion ▶Bupivacaine hydrochloride (Non-proprietary) Bupivacaine hydrochloride 1 mg per 1 ml Bupivacaine 100mg/100ml (0.1%) infusion bags | 20 bag P s Bupivacaine 250mg/250ml (0.1%) infusion bags | 5 bag P £60.87 | 20 bag P £243.48 Bupivacaine hydrochloride 1.25 mg per 1 ml Bupivacaine 312.5mg/250ml (0.125%) infusion bags | 5 bag P £62.12 | 20 bag P £248.47

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Dose text by age group

Adult

75–150 mg, dose administered using a 5 mg/mL

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

Up to 150 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

12.5–50 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

50–150 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

50–175 mg, dose administered using 5 mg/mL

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

Up to 100 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

6.3–18.8 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

6.25–12.5 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

15–37.5 mg, then (by lumbar epidural)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

Up to 150 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

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Adult

10–20 mg

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1442

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Bupivacaine hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1441, 1442

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF pages 1441, 1442

Contra Indications

PDF page 1442

Cautions

PDF page 1442

Allergy And Cross Sensitivity

PDF page 1442

Safety

Important Safety Information

PDF page 1442

Interactions

→Appendix 1: anaesthetics, local

PDF page 1442

Side Effects

PDF page 1442

Pregnancy

Large doses during delivery can cause neonatal respiratory depression, hypotonia, and bradycardia after epidural block. Dose adjustments Use lower doses for intrathecal use during late pregnancy.

PDF page 1442

Breast Feeding

Amount too small to be harmful.

PDF page 1442

Hepatic Impairment

Manufacturer advises use with caution in advanced liver dysfunction.

PDF page 1442

Renal Impairment

Use with caution in severe impairment.

PDF page 1442

Dose and formulations

Medicinal Forms

PDF page 1442

Dose text by age group

Adult

75–150 mg, dose administered using a 5 mg/mL

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

Up to 150 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

12.5–50 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

50–150 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

50–175 mg, dose administered using 5 mg/mL

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

Up to 100 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

6.3–18.8 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

6.25–12.5 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

15–37.5 mg, then (by lumbar epidural)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1441

Adult

Up to 150 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1442

Adult

10–20 mg

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1442

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.