LA + opioid epidural admixture
Bupivacaine with fentanyl
Brand names: various — epidural pre-mix
Adult dose
Dose: Per epidural protocol — typical 0.1% bupivacaine + 2 micrograms/mL fentanyl, 6–12mL/h
Route: Epidural
Frequency: Continuous infusion
Clinical pearls
- OAA labour epidural / RCOA postoperative analgesia
- AAGBI: regional anaesthesia in patients with abnormal coagulation
- Continuous monitoring required (RR, sedation, motor)
Contraindications
- Local infection at insertion
- Coagulopathy / anticoagulation (per AAGBI/RCOA)
- Raised ICP
- Severe hypotension
- Patient refusal
- Hypersensitivity
Side effects
- Hypotension
- Motor block
- Urinary retention
- Respiratory depression (fentanyl)
- Pruritus
- Nausea
- Epidural haematoma / abscess (rare)
Interactions
- Other CNS depressants
- Other opioids
Monitoring
- BP
- RR
- Sedation
- Motor / sensory level
- Pain score
- Urinary output
Reference: BNF; OAA / RCOA / AAGBI guidelines; https://bnf.nice.org.uk/drugs/bupivacaine-with-fentanyl/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Morphine Milligram Equivalents (MME) Calculator · Pain / Opioids
- Opioid Conversion / Equianalgesic Guide · Pain Management
- Local Anaesthetic Maximum Dose Calculator · Drug Dosing
- Numeric Rating Scale (NRS) Pain Assessment and Management · Pain Management
- Finnegan Neonatal Abstinence Scoring Tool (FNAST) · Neonatal Abstinence Syndrome
- Modified Finnegan Neonatal Abstinence Score (NAS) · Neonatal
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