Bupivacaine

General

• Type: Local anesthetics
• Dosage Forms: injectable solution
• Dosage Strengths: 0.25%, 0.5%, 0.75%
• Routes of administration: Infiltration
• Common Trade Names: Marcaine, Sensorcaine

Maximum Doses of Anesthetic Agents

Agent	Without Epinephrine	With Epinephrine	Duration	Notes
Lidocaine	5 mg/kg (max 300mg)	7 mg/kg (max 500mg)	30-90 min	1% soln contains 10 mg/ml 2% soln contains 20 mg/ml
Mepivicaine	7 mg/kg	8 mg/kg
Bupivicaine	2.5 mg/kg (max 175mg)	3 mg/kg (max 225mg)	6-8 hr	0.5% soln contains 5 mg/ml May cause cardiac arrest if injected intravascularly Do not buffer with bicarbonate
Ropivacaine	3 mg/kg
Prilocaine	6 mg/kg
Tetracaine	1 mg/kg	1.5 mg/kg	3hrs (10hrs with epi)
Procaine	7 mg/kg	10 mg/kg	30min (90min with epi)

Special Populations

• Pregnancy Rating: C
• Lactation: Infant risk is minimal
• Renal Dosing
  • Adult
  • Pediatric
• Hepatic Dosing
  • Adult
  • Pediatric

Contraindications

• Allergy to class/drug
• Obstetric paracervical block

Adverse Reactions

• Due to increased potency and duration, higher risk of toxicity than other local anesthetics

Serious

• Negative ionotropy, hypotension, cardiac arrest
• Respiratory arrest
• CNS depression, CNS excitation, bacterial meningitis, seizure

Pharmacology

• Half-life: ~3-8 hours
• Metabolism: Liver
• Excretion:

Mechanism of Action

• Amide-type local anesthetic; stabilizes the neuronal membranes → blocks initiation and transmission of nerve impulses

See Also

• Local Anesthetic Systemic Toxicity (LAST)