Local Anaesthetic (Amide) Pregnancy: No or limited data in pregnant women; animal studies show reproductive toxicity. EXPAREL liposomal is not recommended during pregnancy or in women of childbearing potential not using contraception. Bupivacaine and its metabolite are present in human milk at low levels; decide whether to discontinue breast-feeding or the medicinal product.

Bupivacaine

Brand names: Marcain, Sensorcaine

Bupivacaine is a long-acting amide local anaesthetic used for infiltration, peripheral nerve and plexus blocks, and epidural and spinal anaesthesia.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Liposomal bupivacaine (EXPAREL): dose individualised to surgical site size and volume required; e.g. field block 106 mg (8 mL) for bunionectomy or up to 266 mg (20 mL) for haemorrhoidectomy; peripheral nerve block 133-266 mg (10-20 mL)

Route: Infiltration (field block) or perineural (peripheral nerve block); single-dose only

Frequency: Single dose

Max: 266 mg (20 mL undiluted) must not be exceeded

This bundle's UK SPC is for EXPAREL liposomal bupivacaine (prolonged-release), for adults and children aged 6 years or older; dose is based on surgical site size, volume required to cover the area and individual patient factors. Field block examples: bunionectomy total 106 mg (8 mL); haemorrhoidectomy total 266 mg (20 mL) diluted with 10 mL saline to 30 mL. Peripheral nerve block examples: femoral nerve block for TKA 266 mg (20 mL); brachial plexus block for shoulder surgery 133 mg (10 mL) diluted to 20 mL. May be given 'as is' or expanded with 0.9% saline down to 0.89 mg/mL (1:14 by volume). Administer with a 25 gauge or larger needle to preserve liposome integrity; inject slowly (1-2 mL per injection) with frequent aspiration. Liposomal preparation — NOT interchangeable with other bupivacaine formulations. If admixed with bupivacaine HCl the total must not exceed 400 mg equivalents of bupivacaine HCl in adults, and the HCl:liposomal ratio must not exceed 1:2. Must be given where trained personnel and resuscitation equipment are available. Elderly: no dosage adjustment required but greater sensitivity cannot be ruled out. Hepatic impairment: no adjustment in mild/moderate (Child-Pugh 5-9); insufficient data in severe (Child-Pugh >=10).

Paediatric dose

Dose: 4 mg/kg

Route: Field block (infiltration), single dose

Frequency: Single dose

Max: Not to exceed 266 mg

Liposomal bupivacaine (EXPAREL) in paediatric patients aged 6 years and older, as a single-dose field block for somatic post-operative pain from small- to medium-sized surgical wounds. Not established as a field block in children 1 to <6 years, nor as a nerve block in children 1 to <18 years. Must not be used in children under 1 year. Verify dose against a children's formulary.

Dose adjustments

Renal

Bupivacaine or its metabolites are substantially excreted by the kidney; risk of toxic reactions may be greater in renal impairment. Impaired renal function should be considered when selecting the dose.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

Contraindications

Hypersensitivity to the active substance or any excipient
Hypersensitivity to amide-type local anaesthetics
Obstetrical paracervical block anaesthesia (risk of foetal bradycardia or death)
Intravascular administration
Intra-articular administration

Side effects

Hypoaesthesia oral (>=5%)
Dysgeusia (common)
Vomiting, constipation, nausea (common)
Systemic toxic reactions — serious dysrhythmia, serious hypotension, and (rarely) convulsions or cardiac arrest
Dizziness, somnolence, headache, hypoaesthesia (uncommon)

Interactions

Other local anaesthetics — toxic effects are additive; co-administer with caution and monitor for neurologic and cardiovascular toxicity (LAST)
Bupivacaine HCl (immediate-release) — if admixed, HCl:liposomal ratio must not exceed 1:2 and total must not exceed 400 mg bupivacaine HCl equivalents in adults; redosing/overdose/concomitant local anaesthetics may increase risk of LAST

Clinical monograph

How it works

It reversibly blocks voltage-gated sodium channels in nerve membranes, preventing the initiation and conduction of action potentials and thereby producing local anaesthesia.

Prescribing in practice

Inadvertent intravascular injection or systemic absorption can cause severe, sometimes refractory cardiotoxicity and CNS toxicity, so aspirate before injection, use incremental dosing and have lipid emulsion and resuscitation facilities available.
It has a slower onset but longer duration than many other local anaesthetics, making it suitable for prolonged analgesia.
The plain (non-hyperbaric) preparation is not recommended for intravenous regional anaesthesia owing to the risk of cardiac arrest.

Monitoring

Monitor for early signs of systemic toxicity such as perioral tingling, tinnitus and arrhythmia, with continuous cardiovascular observation during regional blockade.

Counselling the patient

Tell the patient the treated area will feel numb and weak until the block wears off, so protect it from injury.
Advise reporting dizziness, ringing in the ears or a metallic taste immediately.

Evidence & guidelines

Safe use is reinforced by professional guidance on management of local anaesthetic systemic toxicity, including lipid emulsion rescue.

Reference: AAGBI LAST Guidelines 2023; Royal College of Anaesthetists Regional Anaesthesia Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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