bupivacaine at a glance
Medicine class
Amide-type local anaesthetic
Usual role
Local or regional pain control after surgery
Administration
Injected at the surgical site or near nerves by a trained clinician
After treatment
Temporary numbness or reduced movement may persist; protect the affected area and follow advice about driving and mobility
What is bupivacaine used for?
The prolonged-release liposomal product is licensed for postoperative pain control.
Brachial plexus or femoral nerve block in adults.
Field block around small- to medium-sized surgical wounds in adults and children aged 6 years or older.
How does bupivacaine work?
Bupivacaine temporarily prevents nerves from generating and conducting electrical impulses, so fewer pain signals reach the brain. The liposomal formulation releases bupivacaine gradually from lipid particles at the injection site.
How to take bupivacaine
A trained clinician administers this formulation during surgery by injecting it around the surgical site or near an appropriate nerve. It must not be self-administered.
Move carefully while sensation or muscle control is reduced.
Protect numb areas from pressure, heat and injury.
Do not drive or use machinery while sensation or movement remains affected.
bupivacaine side effects
Common or expected effects
- Altered taste
- Numbness in or around the mouth
- Nausea or vomiting
- Constipation
Get urgent medical advice
- Local-anaesthetic systemic toxicity, including seizures, marked drowsiness, loss of consciousness or abnormal heart rhythm
- Severe allergic reaction with swelling, breathing difficulty or collapse
- Methaemoglobinaemia, with blue-grey skin, breathlessness, confusion or chest pain
- Severe low blood pressure or cardiac arrest
bupivacaine in pregnancy
Pregnancy data for the liposomal formulation are limited, and its SmPC does not recommend use during pregnancy or in people who could become pregnant and are not using contraception. Tell the anaesthetic or surgical team if you are pregnant, may be pregnant or are planning pregnancy. Obstetric paracervical block use is contraindicated because of the risk of serious fetal harm.
bupivacaine while breastfeeding
Bupivacaine enters breast milk at low levels, and published studies suggest infant exposure after local use is small. However, infant-effect data for the liposomal product are unavailable, so an individual decision about breastfeeding or treatment is required. Discuss this with the anaesthetic and maternity teams, particularly for a premature or unwell baby.
bupivacaine interactions
The clinical team should review all local anaesthetics and medicines that can increase neurological, cardiac or methaemoglobin toxicity.
Other local anaesthetics
Toxic effects are additive, and some non-bupivacaine local anaesthetics can disrupt the liposomes if mixed directly with this formulation.
Lidocaine or mexiletine
These related anti-arrhythmic agents can add to bupivacaine's neurological and cardiac toxicity.
Oxidising medicines, including nitrates, dapsone, nitrofurantoin, primaquine and rasburicase
Combined use may increase the risk of methaemoglobinaemia.
Common questions about bupivacaine
Answers are fully visible for fast scanning and source review.
What is bupivacaine used for after surgery?
The liposomal formulation numbs the surgical area or nearby nerves to reduce postoperative pain.
Is Exparel the same as ordinary bupivacaine?
No. Exparel is a prolonged-release liposomal formulation and is not interchangeable or directly convertible with immediate-release bupivacaine products.
How is bupivacaine given?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.