Bupivacaine hydrochloride (Marcaine®)

Section 1.1

Midwives may independently prescribe, order and administer this drug.

Without epinephrine. Bupivicaine is an amide-type local anaesthetic that blocks the initiation and conduction of nerve impulses.

Indications and Clinical Use:

Used to anaesthetize the perineum and vaginal walls for repair of laceration or an emergency episiotomy.


Hypersensitivity to bupivacaine, amide type local anesthetics (lidocaine, mepivacaine, ropivacaine), or any component of the formulation.

Warnings and Precautions:

Use with caution in patients with cardiovascular disease including patients with hypotension or heart block.

Use with caution in patients with hepatic impairment.


Bupivacaine is approved for use at term in obstetrical anesthesia or analgesia.


Category L2 – Limited Data – Probably Compatible

Adverse Reactions:

Hypotension, bradycardia, palpitation, restlessness, anxiety, dizziness, pruritus, urticarial and anaphylaxis.

Dosage and Administration:

Usual Concentration: 0.25% (2.5 mg/mL). Maximum individual dose should not exceed 2 mg/kg of body weight and in general the maximum total dose should not exceed 175 mg or 70 mL. Usual maximum dose is 12.5 mg to 37.5 mg or 5-15 mL.

Subcutaneous administration is the route of choice – only the lowest dose needed to provide effective anaesthesia should be administered. Injections should always be made slowly and with frequent aspirations to avoid inadvertent rapid intravascular administration which can produce increased systemic absorption and toxicity.

Onset of Action:

10-15 minutes (slightly slower acting than lidocaine)


2.7 hours
Time to peak, plasma: 30-45 minutes


Urine (6% as unchanged drug)