Marcaine (Bupivacaine) – Complete Product Information

Marcaine (bupivacaine hydrochloride) represents a cornerstone in modern anesthesia practice, offering superior duration and potency compared to other local anesthetics. As an amide-type local anesthetic, bupivacaine works by blocking sodium channels in nerve membranes, preventing the generation and conduction of nerve impulses that transmit pain signals to the brain.

The medication’s mechanism involves increasing the threshold for electrical excitation in nerve fibers, slowing nerve impulse propagation, and reducing the rate of action potential rise. This creates a progressive loss of sensation in the following order: pain, temperature, touch, proprioception, and finally skeletal muscle tone. The drug’s high lipid solubility and protein binding capacity contribute to its prolonged duration of action, with effects lasting 4-8 hours depending on the concentration and injection site.

Marcaine is available in three concentrations – 0.25%, 0.5%, and 0.75% – each designed for specific procedures and levels of motor blockade required. The 0.25% concentration provides sensory block with minimal motor impairment, while the 0.75% solution produces complete motor block necessary for major abdominal surgeries. Formulations with epinephrine 1:200,000 extend duration and reduce systemic absorption by causing local vasoconstriction.

Clinical Applications and Effectiveness: Marcaine’s versatility makes it suitable for numerous procedures including epidural anesthesia, peripheral nerve blocks, local infiltration, dental procedures, and retrobulbar blocks for eye surgery. The medication’s long duration reduces the need for repeated injections, improving patient comfort and procedural efficiency.

For patients requiring pain management medications, Marcaine offers several advantages over shorter-acting anesthetics. The extended analgesic period often persists beyond complete motor recovery, providing postoperative pain relief that reduces opioid requirements. This characteristic makes it particularly valuable for outpatient procedures where prolonged pain control is desired.

Pharmacokinetics and Duration: After injection, Marcaine reaches peak plasma levels within 30-45 minutes, with effects beginning within 2-10 minutes for most applications. The drug undergoes hepatic metabolism via conjugation with glucuronic acid, with only 6% excreted unchanged in urine. The elimination half-life averages 2.7 hours in adults but extends to 8.1 hours in neonates, requiring dosage adjustments in pediatric populations.

The medication’s high protein binding (95%) contributes to its prolonged duration while reducing placental transfer, making it suitable for obstetrical procedures when used in appropriate concentrations. Plasma protein binding can be affected by acidosis, systemic diseases, or competition from other drugs, potentially altering individual tolerance and effectiveness.

Safety Considerations and Monitoring: While highly effective, Marcaine requires careful administration due to its potential for serious cardiovascular and central nervous system toxicity. The drug’s long duration means that toxic effects, if they occur, may persist for several hours. Proper dosing, incremental injection techniques, and continuous monitoring are essential for safe use.

The medication should be used with particular caution in elderly patients, those with cardiovascular disease, and patients with hepatic impairment who may have reduced drug clearance. Aspiration before injection is critical to avoid intravascular administration, which can lead to rapid systemic toxicity and potentially fatal cardiac arrhythmias.

For patients managing complex surgical procedures, coordination with anesthesiologists and pain management specialists is essential. Those exploring affordable surgical medication options should work with qualified healthcare providers to ensure proper procedure selection, appropriate dosing, and ongoing monitoring for both therapeutic effectiveness and potential complications, as anesthetic medications require specialized expertise and should never be administered without appropriate medical supervision and emergency preparedness protocols.

Brand	Marcaine Heavy, Marcaine Brand
Form	0.5% 5 x 4mL Vial, 0.5% 20mL Vial

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Marcaine can cause various side effects ranging from common local reactions to serious systemic toxicity. Most adverse effects are dose-related and result from high plasma levels due to overdosage, rapid absorption, or unintentional intravascular injection.

Central Nervous System Effects:

Early CNS stimulation: Restlessness, anxiety, dizziness, tremors
Sensory disturbances: Tinnitus, blurred vision, metallic taste
Speech problems: Slurred or incoherent speech
Numbness: Tingling of mouth, lips, and tongue
Progression to convulsions: Tonic-clonic seizures
CNS depression: Drowsiness progressing to unconsciousness
Respiratory depression: Reduced breathing rate and depth
Respiratory arrest: Complete cessation of breathing

Cardiovascular System Reactions:

Myocardial depression: Reduced heart muscle contractility
Bradycardia: Abnormally slow heart rate
Hypotension: Dangerously low blood pressure
Heart block: Disrupted electrical conduction
Ventricular arrhythmias: Irregular heartbeats originating in ventricles
Ventricular tachycardia: Rapid ventricular heart rate
Ventricular fibrillation: Chaotic ventricular rhythm
Cardiac arrest: Complete heart stoppage
Decreased cardiac output: Reduced blood circulation

Allergic and Hypersensitivity Reactions:

Urticaria: Hives and skin welts
Pruritus: Severe itching
Erythema: Skin redness and inflammation
Angioedema: Swelling of face, lips, throat
Laryngeal edema: Throat swelling affecting breathing
Bronchospasm: Airway constriction
Anaphylaxis: Severe systemic allergic reaction
Tachycardia: Rapid heart rate from allergic response

Neurologic Complications:

High spinal block: Excessive spread of epidural anesthesia
Total spinal block: Complete paralysis including respiratory muscles
Persistent anesthesia: Prolonged numbness beyond expected duration
Paresthesia: Abnormal tingling or burning sensations
Motor weakness: Temporary or permanent muscle weakness
Paralysis: Loss of motor function
Sphincter dysfunction: Loss of bladder or bowel control
Sexual dysfunction: Temporary loss of sensation and function

Epidural and Spinal Anesthesia Complications:

Hypotension: Blood pressure drop from sympathetic blockade
Urinary retention: Inability to empty bladder
Headache: Spinal headache from dural puncture
Backache: Pain at injection site
Meningitis: Infection of spinal membranes
Epidural hematoma: Blood collection in epidural space
Neurological deficits: Permanent nerve damage
Cauda equina syndrome: Lower spinal nerve compression

Local Injection Site Reactions:

Pain and tenderness: Discomfort at injection site
Swelling and inflammation: Local tissue reaction
Tissue necrosis: Death of surrounding tissue
Infection: Bacterial contamination of injection site
Nerve damage: Direct trauma to nerve structures
Hematoma formation: Blood collection from vessel injury

Systemic Effects from Absorption:

Nausea and vomiting: Gastrointestinal upset
Chills: Uncontrolled shivering
Pupil constriction: Reduced pupil size
Elevated temperature: Mild fever response
Excessive sweating: Increased perspiration
Syncope: Fainting episodes

Obstetrical Use Complications:

Maternal hypotension: Dangerous blood pressure drops
Fetal bradycardia: Reduced fetal heart rate
Prolonged labor: Extended second stage of delivery
Increased forceps delivery: Need for assisted delivery
Diminished maternal reflexes: Reduced pushing effectiveness
Neonatal effects: Temporary muscle tone reduction in newborns

Special Population Risks:

Elderly patients: Increased sensitivity and hypotension risk
Cardiac disease patients: Enhanced cardiovascular depression
Hepatic impairment: Prolonged drug elimination
Pediatric patients: Higher risk of systemic toxicity
Pregnant patients: Potential for maternal and fetal complications

Drug Interaction Effects:

MAOI interactions: Severe hypertension with epinephrine formulations
Tricyclic antidepressants: Enhanced cardiovascular effects
Beta-blockers: Masked early signs of toxicity
Ergot alkaloids: Persistent severe hypertension
Phenothiazines: Altered epinephrine effects

Emergency Signs Requiring Immediate Medical Attention:

Sudden confusion or agitation: Early CNS toxicity signs
Seizure activity: Any form of convulsions
Breathing difficulties: Respiratory depression or arrest
Chest pain or palpitations: Cardiac involvement
Severe allergic reactions: Swelling, rash, difficulty breathing
Loss of consciousness: CNS depression
Severe hypotension: Dangerous blood pressure drops

Critical Safety Warning: Marcaine 0.75% concentration is not recommended for obstetrical use due to reports of cardiac arrest with difficult resuscitation. The medication should only be administered by clinicians experienced in local anesthetic toxicity management with immediate access to resuscitation equipment and trained personnel.

Overdose Management: Treatment focuses on maintaining airway, breathing, and circulation. Immediate oxygen administration, assisted ventilation, and cardiovascular support are essential. Lipid emulsion therapy may be considered for severe bupivacaine toxicity to help bind the drug and reduce cardiac effects.

Marcaine (bupivacaine hydrochloride) has extensive FDA-approved indications for producing local or regional anesthesia across numerous medical, surgical, and dental procedures, based on decades of clinical research demonstrating its effectiveness and appropriate safety profile when used correctly:

Primary Indications:

Surgical Anesthesia:

Abdominal surgery: Complete motor blockade with 0.75% concentration
Orthopedic procedures: Joint surgeries, bone procedures, extremity operations
Urological surgery: Procedures requiring regional anesthesia
Gynecological surgery: Non-obstetrical procedures in appropriate concentrations
Plastic and reconstructive surgery: Extended procedures requiring prolonged anesthesia
General surgery: Various procedures requiring regional anesthetic techniques

Obstetrical Procedures:

Labor epidural analgesia: 0.25% and 0.5% concentrations only
Cesarean section anesthesia: Epidural or spinal techniques
Episiotomy repair: Local infiltration for postpartum procedures
Pudendal block: Pain relief during delivery
Caudal anesthesia: Lower body procedures during pregnancy

Dental and Oral Surgery:

Complex extractions: Extended duration for surgical tooth removal
Periodontal surgery: Gum procedures requiring prolonged anesthesia
Endodontic procedures: Root canal and related treatments
Oral surgery: Implant placement, jaw surgery, tumor removal
Maxillofacial procedures: Complex facial and jaw reconstructions

Administration Routes and Concentrations:

Local Infiltration (0.25%):

Wound repair: Extended anesthesia for complex closures
Minor surgical procedures: Skin lesion removal, biopsies
Postoperative pain control: Local injection for continued pain relief
Diagnostic procedures: Painful investigative techniques

Peripheral Nerve Block (0.25% and 0.5%):

Brachial plexus block: Upper extremity surgery anesthesia
Sciatic nerve block: Lower extremity procedures
Femoral nerve block: Thigh and knee surgery
Intercostal blocks: Chest wall procedures and pain management
Digital blocks: Finger and toe procedures
Ankle blocks: Foot surgery anesthesia

Epidural Anesthesia (0.25%, 0.5%, 0.75%):

Lumbar epidural: Lower abdominal and lower extremity surgery
Thoracic epidural: Upper abdominal and chest procedures
Continuous epidural: Extended surgeries and postoperative pain control
Labor analgesia: Pain relief during childbirth (0.25% and 0.5% only)

Caudal Block (0.25% and 0.5%):

Pediatric procedures: Lower body surgery in children over 12
Perineal surgery: Procedures involving genital and anal areas
Lower extremity procedures: Leg and foot surgeries
Urological procedures: Bladder and prostate operations

Specialized Applications:

Retrobulbar block (0.75%): Eye surgery requiring complete akinesia
Sympathetic block (0.25%): Chronic pain management
Epidural test dose (0.5% with epinephrine): Safety verification before full dose

Dosing Guidelines and Administration:

Maximum Dosage Recommendations:

Without epinephrine: Maximum 175 mg per procedure
With epinephrine 1:200,000: Maximum 225 mg per procedure
Daily maximum: 400 mg in 24 hours (until further experience gained)
Repeat dosing: May repeat up to every 3 hours as needed
Elderly patients: Reduced doses based on physical status

Concentration-Specific Effects:

0.25% solution: Incomplete motor block, suitable for procedures not requiring muscle relaxation
0.5% solution: Moderate motor blockade, adequate for most surgical procedures
0.75% solution: Complete motor block, reserved for abdominal surgery and retrobulbar anesthesia

How long does Marcaine last compared to other anesthetics?

Marcaine provides significantly longer anesthesia than most other local anesthetics. While lidocaine typically lasts 1-2 hours, Marcaine can provide 4-8 hours of pain relief depending on the concentration and location of injection. Dental injections may last up to 7 hours, which is two to three times longer than lidocaine or mepivacaine for similar procedures.

Why cant I use the 0.75% concentration for childbirth?

The 0.75% concentration of Marcaine is contraindicated for obstetrical anesthesia due to reports of cardiac arrest with difficult resuscitation in pregnant women. Most cases involved the 0.75% strength, and resuscitation proved extremely challenging or impossible despite proper preparation. Only 0.25% and 0.5% concentrations should be used for labor and delivery procedures.

What should I expect during recovery from Marcaine anesthesia?

Recovery from Marcaine follows a predictable pattern with sensation returning before motor function. You may experience a period of continued pain relief even after some feeling returns. During recovery, avoid chewing, biting, or applying heat to numb areas to prevent injury. Complete recovery typically occurs within 4-12 hours depending on the dose and injection site.

Can Marcaine be used with other anesthetics?

Mixing Marcaine with other local anesthetics is generally not recommended due to insufficient data on clinical safety and effectiveness of such combinations. If multiple anesthetics are needed, they should be administered separately with appropriate time intervals. Your anesthesiologist will determine the safest approach for your specific procedure.

Why do I need to avoid certain activities after dental Marcaine?

Due to Marcaine's long duration (up to 7 hours for dental procedures), theres significant risk of inadvertent trauma to numb tissues. Patients should avoid chewing solid foods, drinking hot beverages, or testing the numb area by biting or probing until sensation fully returns. This prevents injuries to tongue, lips, and inside of the mouth that you wouldnt feel occurring.

Is Marcaine safe during pregnancy and breastfeeding?

Marcaine is considered relatively safe during pregnancy when used appropriately, with high protein binding reducing placental transfer. However, only 0.25% and 0.5% concentrations should be used for obstetrical procedures. The medication is excreted in breast milk, so nursing mothers should discuss timing of procedures and potential temporary interruption of breastfeeding with their healthcare provider.

How is Marcaine toxicity treated if it occurs?

Treatment focuses on immediate airway management, oxygen administration, and cardiovascular support. Seizures are controlled with anticonvulsants, and cardiac arrhythmias require specific antiarrhythmic protocols. Lipid emulsion therapy has shown promise in severe bupivacaine toxicity. All facilities using Marcaine must have immediate access to resuscitation equipment and trained personnel.

Can elderly patients safely receive Marcaine?

Elderly patients can receive Marcaine but require lower doses and careful monitoring. Age-related changes in drug metabolism and cardiovascular function increase sensitivity to both therapeutic and toxic effects. Blood pressure monitoring is particularly important as elderly patients, especially those with hypertension, face higher risk of significant hypotension during anesthesia.

What makes Marcaine different from lidocaine?

The primary differences are duration and potency. Marcaine lasts 3-4 times longer than lidocaine, has higher potency, and provides more complete motor blockade. However, Marcaine also has greater potential for cardiovascular toxicity and requires more careful administration. The choice between them depends on procedure duration, need for motor blockade, and patient factors.

How quickly does Marcaine start working?

Marcaine typically begins working within 2-10 minutes after injection, though onset can vary by location and concentration. Dental injections usually provide anesthesia within 2-10 minutes, while epidural administration may take 10-20 minutes for full effect. The 0.25% concentration may have slower onset than higher concentrations but still provides reliable anesthesia.

What should I tell my doctor before receiving Marcaine?

Inform your healthcare provider about all medications, allergies to local anesthetics, heart conditions, liver disease, breathing problems, and any previous reactions to anesthesia. Mention if youre taking blood thinners, heart medications, antidepressants, or MAO inhibitors. Pregnant or breastfeeding women should discuss timing and concentration selection for optimal safety.

Can I drive after receiving Marcaine?

Avoid driving until the anesthetic effect completely wears off and you feel fully alert. Marcaine can cause temporary blurred vision, dizziness, or drowsiness, especially in the first hour after injection. For dental procedures, wait until lip and tongue sensation fully returns. For epidural anesthesia, additional recovery time and medical clearance are typically required.

How is Marcaine stored and prepared?

Marcaine should be stored at room temperature (68-77°F) and protected from light if it contains epinephrine. Solutions without epinephrine can be autoclaved if needed. Epinephrine-containing solutions shouldnt be used if they turn pink or darker than slightly yellow, or if they contain precipitates. Single-dose vials should be discarded after initial use.

Are there alternatives if I cant use Marcaine?

Several alternatives exist including other pain management medications and different local anesthetics like lidocaine, mepivacaine, or chloroprocaine. The choice depends on your specific medical conditions, allergies, and procedure requirements. Your anesthesiologist can recommend the safest and most effective alternative for your situation.

Brand	Form	Price	Qty	Action
Marcaine Heavy	0.5% 5 x 4mL Vial	$15.00	Marcaine quantity
Marcaine Brand	0.5% 20mL Vial	$11.00	Marcaine quantity

Marcaine