Long-acting amide LA + vasoconstrictor
Bupivacaine with adrenaline
Brand names: Marcain with Adrenaline
Adult dose
Dose: Max 2mg/kg plain or 2.5mg/kg with adrenaline (max 175mg per dose plain, 225mg with adrenaline)
Route: Infiltration / Peripheral block
Frequency: Per indication
Clinical pearls
- Adrenaline prolongs duration and reduces LA absorption — 1:200,000 typical
- AAGBI LAST guideline; Intralipid availability mandatory
- Avoid in end-arterial regions
Contraindications
- End-arterial blocks (digit, penis, nose) — absolute
- IV regional anaesthesia
- Severe cardiac disease
- Concurrent MAOI
- Hypersensitivity
Side effects
- LAST
- Tissue ischaemia (end arteries)
- Tachycardia / hypertension (adrenaline)
- Necrosis at injection site
Interactions
- MAOIs
- Tricyclics
- Beta-blockers
- Volatile anaesthetics
Monitoring
- ECG
- BP
- Local perfusion
- LAST symptoms
Reference: BNF; AAGBI LAST guideline; SmPC; https://bnf.nice.org.uk/drugs/bupivacaine-with-adrenaline/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Local Anaesthetic Maximum Dose Calculator · Drug Dosing
- Corrected QT Interval (Bazett) · ECG
- Bazett Corrected QT Interval (QTc) Calculator · Arrhythmia
- Long QT Syndrome (Schwartz Score) · Channelopathy / Sudden Cardiac Death
- FAST Exam Protocol — Focused Assessment with Sonography in Trauma · Trauma
- Westley Croup Score · Respiratory
Pathways
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Anaphylaxis Under Anaesthesia · AAGBI 2018; NAP6
- Malignant Hyperthermia · AAGBI 2011; MHAUS
- Local Anaesthetic Systemic Toxicity (LAST) · AAGBI 2010; ASRA 2017
- Spinal Anaesthesia Hypotension Management · AAGBI; ASA
- Postoperative Nausea & Vomiting · Society for Ambulatory Anesthesia 2020; AAGBI