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Bupivacaine and glucose parenteral

Updated 2 Feb 2023 | Bupivacaine


Injection containing bupivacaine hydrochloride in hypertonic glucose solution.

Drugs List

  • bupivacaine 20mg/4ml (0.5%) and glucose 320mg/4ml (hypertonic) intrathecal injection
  • BUPIVACAINE HEAVY 20mg/4ml solution for injection ampoule
  • MARCAIN HEAVY 0.5% injection
  • Therapeutic Indications


    Spinal anaesthesia for abdominal surgery lasting 45-60 minutes
    Spinal anaesthesia for lower abdominal surgery lasting 1.5-3 hours
    Spinal anaesthesia for urological and limb surgery lasting 2 - 3 hours
    Spinal anaesthesia for urological and lower limbs surgery lasting 1.5-3 hrs


    When using this agent, specialist literature, national guidelines and Trust policies should be consulted to ensure appropriate dosage and assessment of patient factors.


    2ml to 4ml (10mg to 20mg bupivacaine hydrochloride).


    Children aged 12 to 18 years
    (see Dosage; Adult)

    Neonates and children under 12 years
    Body weight 15kg to 40kg: 0.25mg/kg to 0.3mg/kg.
    Body weight 5kg to 15kg: 0.3mg/kg to 0.4mg/kg.
    Body weight below 5kg: 0.4mg/kg to 0.5mg/kg.

    Additional Dosage Information

    In patients who are in the last stages of pregnancy, reduce dose by 20-30%.


    For intrathecal injection only.

    The recommended site of injection is below L3 intervertebral space.

    When injected at L3 to L4, while the patient is sitting, 3ml of bupivacaine hydrochloride spreads to the T7 to T10 spinal segments.
    When injected while the patient is in a horizontal position and then turned supine, the blockade spreads to T4 to T7 spinal segments.

    If the anaesthesia appears inadequate, changing the position of the patient within twenty minutes of administration may improve distribution of the local anaesthetic agent within the subarachnoid space.

    If the anaesthesia fails, a new attempt can be made to administer the anaesthetic agent at a different level of the spinal cord, using a smaller volume of the drug.


    Administration site infection
    Hypovolaemic shock
    Inflammation of injection site
    Spinal stenosis
    Cardiogenic shock
    Central nervous system disorder
    Central nervous system neoplasm
    Intracranial haemorrhage
    Spinal cord injury
    Subacute combined degeneration of spinal cord due to B12 deficiency
    Tuberculosis of spine

    Precautions and Warnings

    Cardiac conduction defects
    Cardiovascular disorder
    Epileptic disorder
    Multiple sclerosis
    Myasthenia gravis
    Neuromuscular disorder
    Pleural effusion
    Respiratory impairment
    Severe hepatic impairment
    Severe myocardial depression
    Severe renal impairment

    Septicaemia increases risk of post-op intraspinal abscess formation
    Advise ability to drive/operate machinery may be affected by side effects
    Not all available brands are licensed for all indications
    Treatment to be initiated and supervised by a specialist
    Do not inject near site of skin infection
    Resuscitation facilities must be immediately available
    Monitor vital signs, respiration & cardiac function
    Discontinue if signs of acute systemic toxicity or total spinal block occur
    Maintain treatment at the lowest effective dose
    Reduce dose in debilitated patients
    Reduce dose in elderly
    Reduce dose when given in late stages of pregnancy

    Intrathecal anaesthesia can lead to hypotension and bradycardia. Precautions against these effects should be taken and may include pre-loading the circulation with crystalloid or colloid solution. If hypotension occurs, it should be treated appropriately. Marked hypotension should be avoided in patients with cardiac decompensation.

    Intravenous access should be in place before commencing with intrathecal anaesthesia.

    Intrathecal anaesthesia can cause intercostal paralysis and patients with pleural effusions may suffer respiratory embarrassment.

    Pregnancy and Lactation


    Use bupivacaine and glucose with caution during pregnancy.

    The manufacturer advises caution if bupivacaine and glucose is used during pregnancy. Available reports indicate no increased risk of teratogenic or developmental effects. However, in patients who are in the late stages of pregnancy, the manufacturer advises that dose should be reduced due to the risk of neonatal respiratory depression, hypotension and bradycardia.


    Bupivacaine and glucose is considered safe for use during breastfeeding.

    The manufacturer states bupivacaine and glucose may be used safely when breastfeeding. Bupivacaine is present in human breast milk, but the quantities are so small and it is not orally absorbed, that there is generally no risk to the child at therapeutic doses. Cases of breastfed infants exposed to bupivacaine have shown no adverse effects.

    Side Effects

    Abscess formation (injection site)
    Allergic reaction
    Anaphylactic shock
    Back pain
    Cardiac arrest
    Muscle weakness
    Postdural puncture headache
    Respiratory depression
    Urinary incontinence
    Urinary retention


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: August 2013

    Reference Sources

    Summary of Product Characteristics: Marcain Heavy, 0.5% solution for injection. AstraZeneca UK Ltd. Revised March 2013.

    Summary of Product Characteristics: Bupivacaine Heavy 5 mg/ml Solution for Injection. Panpharma UK Ltd. Revised April 2019.

    NICE Evidence Services Available at: Last accessed: 06 October 2022

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