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LA + opioid epidural admixture

Bupivacaine with fentanyl

Brand names: various — epidural pre-mix

A combination of the long-acting amide local anaesthetic bupivacaine with the opioid fentanyl, used principally for epidural and intrathecal analgesia, including labour and postoperative pain.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Bupivacaine blocks neuronal sodium channels to produce a sensory and motor block, while fentanyl, an opioid agonist acting on spinal opioid receptors in the dorsal horn, provides synergistic analgesia allowing a lower local-anaesthetic concentration.

Prescribing in practice

  • The fentanyl component can cause delayed respiratory depression after neuraxial administration, so monitor respiration and sedation and have naloxone and resuscitation facilities available.
  • Bupivacaine remains cardiotoxic if injected intravascularly, so correct catheter placement and aspiration are essential before dosing.
  • Neuraxial opioids may also cause pruritus, urinary retention and nausea; use only where appropriate monitoring is in place.

Monitoring

Monitor respiratory rate, sedation level, blood pressure and block height regularly throughout neuraxial infusion.

Counselling the patient

  • Team: observe for delayed respiratory depression and excessive sedation after neuraxial opioid use.
  • Patient: report itching, difficulty passing urine, drowsiness or difficulty breathing.

Evidence & guidelines

Combining low-dose local anaesthetic with a neuraxial opioid for synergistic epidural analgesia is well-established obstetric and perioperative practice.

Reference: OAA / RCOA / AAGBI guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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