• Local anesthesia:
    • Up to 175mg (0.25% conc) via infiltration *1
  • Regional anesthesia:
    • Sympathetic block:
      • 50-125mg (0.25% conc) perineurally *1
    • Retrobulbar block:
      • 15-30mg (0.75% conc) retrobulbar injection *1
    • Peripheral nerve block:
      • 25-175mg (0.5% conc) OR5-175mg (0.25% conc) perineurally *1
    • Caudal block:
      • 75-150mg (0.5% conc Methyl-paraben Free (MPF)) OR 5-75mg (0.25% conc MPF) intracaudally *1
    • Lumbar epidural block:
      • 50-100mg (0.5% conc MPF) OR 25-50mg (0.25% conc. MPF) OR 75-150mg (0.75% conc. MPF) epidurally *1
      • Do not use 0.75% conc for obstetrics
  • Spinal anesthesia:
    • Lower abdominal procedures:
      • 12mg (0.75% heavy) intrathecally *1
    • Lower extremity or perineural procedures:
      • 5mg (0.75% heavy) intrathecally *1
    • Obstetrical procedures, vaginal delivery* (not recommended for epidural):
      • 6mg (0.75% heavy) intrathecally *1
  • Obstetrical procedures, cesarean section:
    • 5-10.5mg (0.75% heavy) intrathecally *1

Injection:

Plain bupivacaine: 5mg/mL; 100mg/20mL

Heavy bupivacaine: 5mg/mL + dextrose 80mg/mL

NB: Heavy vs plain bupivacaine: heavy bupivacaine is produced by the addition of glucose (80mg/mL) to isobaric or plain bupivacaine. The difference in density between the two forms is believed to affect their diffusion patterns and distribution after injection into the intrathecal space

  • For local/regional anesthesia:
    • Max: 400mg/24h
    • May repeat dose every 3 hours PRN
    • Onset 2-10min
    • Peaks at 30-45min
    • Duration of action 3-6 hours
  • For spinal anesthesia:
    • Onset <1min
    • Peak at 15min
    • Duration of action 3-6 hours
    • Ready to use, no mixing required

Amide local anesthetic

It decreases permeability of Na ion channels, stabilizing neuronal cell membranes and inhibiting nerve impulse initiation and conduction.

  • Hypotension
  • Nausea
  • Vomiting
  • Constipation
  • Taste disturbance
  • Paresthesia
  • Pain
  • Bradycardia
  • Headache
  • Fever
  • Rigors
  • Dizziness
  • Injection site burning
  • Pruritus
  • Drowsiness
  • Hypersensitivity to drug/class/components
  • Hypersensitivity to amide anesthetics
  • Coagulopathy (spinal anesthesia use)
  • Severe impaired cardiac function (spinal anesthesia use)
  • Sepsis (spinal anesthesia use)
  • Injection site infection (spinal anesthesia use)
  • Intra-articular continuous infusion use
  • IV regional anesthesia use
  • Obstetrical paracervical block,
  • Obstetrical anesthesia (0.75% conc except hyperbaric form)
  • Caudal use (methylparaben-containing form)
  • Epidural use (methylparaben-containing form)
  • Intrathecal use (except 0.75% hyperbaric form)
  • Topical lidocaine
  • Topical prilocaine

                          Drug Status

Availability Prescription only
Pregnancy Contraindicated for obstetrical paracervical block
Breastfeeding Use with caution
Schedule Not controlled
BRAND NAME STRENGTH FORMULATION PACK SIZE MANUFACTURER DISTRIBUTOR
Betolina 20mg/4mL Injection 1’s Pharma Jordan Generics Africa
Bupican 100mg/20mL Injection 1’s Elda International Reddys Pharma
Bupimax Plain 100mg/20mL Injection 1’s Galaxy Pharma Galaxy Pharma
Bupitroy 20mg/4mL Injection 1’s Troikaa Harley’s Ltd
Marcaine 0.5 % 5mg/mL Injection 5’s Beta Healthcare Beta Healthcare
Anawin Heavy 20mg/4mL Injection 5’s Neon Labs Ripple Pharma
Bupiver-H 20mg/4mL Injection 1’s Verve Human Care Generics Africa
Bupimax Heavy 20mg/4mL Injection 10’s Galaxy Pharma Galaxy Pharma
Bupitroy Heavy 20mg/4mL Injection 5’s Troikaa Harley’s Ltd
Bupican Heavy 20mg/4mL Injection 1’s Elda International Reddys Pharma
Marcaine Spinal 0.5 % Heavy 20mg/4mL Injection 5’s Beta Healthcare Beta Healthcare
Bupi Heavy 20mg/4mL Injection 5’s Popular Pharma Madawa Pharma
Bupivacaine in Dextrose 5mg/4mL Injection 10’s Questa Care C/O Surgilinks Surgilinks Ltd
Bupivacaine in Dextrose 5mg/4mL Injection 1’s Asence Pharma Medisel Kenya