Bupivacaine (Orthopaedic Nerve Blocks)

How it works

Bupivacaine reversibly blocks voltage-gated sodium channels in nerve membranes, preventing depolarisation and the conduction of nociceptive impulses along the targeted nerve.

Prescribing in practice

• Inadvertent intravascular injection or exceeding maximum safe doses can cause local anaesthetic systemic toxicity with seizures and cardiac arrest, so aspirate before injection, observe maximum dose limits and have lipid emulsion rescue available.
• Bupivacaine is more cardiotoxic than other amide local anaesthetics and must never be used for intravenous regional anaesthesia.
• Use care in hepatic impairment and with other local anaesthetics or antiarrhythmics that share sodium-channel effects.

Monitoring

Monitor cardiovascular status, conscious level and for early signs of systemic toxicity during and after administration of the block.

Counselling the patient

• The treated area will be numb for several hours; protect it from injury and avoid bearing weight or applying heat until sensation returns.
• Report dizziness, ringing in the ears, a metallic taste, numbness around the mouth or palpitations immediately.

Evidence & guidelines

Use of bupivacaine for peripheral nerve blocks is well established, with safety practice underpinned by guidance on managing local anaesthetic systemic toxicity.