Bupivacaine with adrenaline

How it works

Bupivacaine blocks neuronal voltage-gated sodium channels to abolish nerve conduction, while adrenaline produces local vasoconstriction that slows systemic absorption, prolongs the anaesthetic effect and reduces local bleeding.

Prescribing in practice

• Avoid intravascular injection: bupivacaine is highly cardiotoxic and the adrenaline component adds risk of severe hypertension and arrhythmia, so aspirate carefully before injecting.
• Do not use adrenaline-containing solutions for ring blocks of digits, the penis or other areas supplied by end-arteries, where vasoconstriction risks ischaemic tissue damage.
• Use with caution alongside tricyclic antidepressants, non-selective beta-blockers and in cardiovascular disease or hyperthyroidism, where the pressor response may be exaggerated.

Monitoring

Monitor cardiovascular status and watch for signs of local-anaesthetic systemic toxicity during and after injection.

Counselling the patient

• The treated area will be numb for several hours; avoid injury until full sensation returns.
• Report palpitations, tremor, dizziness, tinnitus or circumoral tingling promptly.

Evidence & guidelines

The principle that adrenaline-containing local anaesthetics must be avoided in end-artery sites is long-established surgical and anaesthetic practice.