Bupivacaine is a local anaesthetic drug belonging to the amino amide group. Bupivacaine is indicated for local anesthesia including infiltration, nerve block, epidural, and intrathecal anesthesia. Bupivacaine often is administered by epidural injection before total hip arthroplasty. It also is commonly injected to surgical wound sites to reduce pain for up to 20 hours after the surgery. Sometimes, bupivacaine is co-administered with epinephrine to prolong the duration of its action, fentanyl for epidural analgesia, or glucose. Bupivacaine binds to the intracellular portion of sodium channels and blocks sodium influx into nerve cells, which prevents depolarization. Bupivacaine also blocks specific potassium channels, an effect contributing to resting membrane potential depolarization. Bupivacaine is contraindicated for intravenous regional anaesthesia (IVRA) because of potential risk of tourniquet failure and systemic absorption of the drug.
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