Bupivacaine is a long-acting local anesthetic injection used to numb specific areas of the body during surgery, labor and delivery, dental procedures, and pain management.

What Is Bupivacaine?

Bupivacaine (brand names: Marcaine, Sensorcaine, Sensorcaine-MPF) is an amide-type local injectable anesthetic. It's one of the most widely used local anesthetics in medicine, valued for its long duration of action compared to alternatives like Lidocaine.

The generic form is manufactured by several companies including Hospira, Fresenius Kabi, and Auromedics. Brand-name versions include Marcaine and Sensorcaine (Pfizer). There are also specialized formulations:

• Exparel (Pacira BioSciences) — A liposomal formulation that releases Bupivacaine slowly over time for extended postoperative pain relief
• Xaracoll (Innocoll) — A Bupivacaine-containing collagen implant placed directly in the surgical site

Bupivacaine is not a controlled substance. It has no DEA schedule and no abuse potential. It was first approved by the FDA in the 1970s and has been a staple of anesthesia practice ever since.

What Is Bupivacaine Used For?

Bupivacaine has a wide range of FDA-approved uses:

• Surgical anesthesia — Local or regional anesthesia for general, orthopedic, plastic, and cardiothoracic surgery
• Epidural anesthesia — Used during labor and delivery to manage pain (note: it is not approved for paracervical block)
• Spinal (subarachnoid) anesthesia — For procedures on the lower body
• Peripheral nerve blocks — Blocking specific nerves to numb an arm, leg, or other region
• Dental procedures — Oral surgery and dental work requiring extended numbness
• Diagnostic and therapeutic procedures — Various medical procedures that require local pain control
• Postoperative pain management — Especially with Exparel (liposomal formulation) or Xaracoll (implant)

Bupivacaine is also used off-label for:

• Chronic pain management via nerve blocks
• Intercostal nerve blocks for rib fractures
• Wound infiltration for postoperative pain
• Transversus abdominis plane (TAP) blocks

For more on how Bupivacaine works at the cellular level, see our article on Bupivacaine's mechanism of action.

How Is Bupivacaine Given?

Bupivacaine is always administered by a healthcare professional — it is not a medication you take at home. It's given by injection in various ways depending on the procedure:

• Epidural injection — Into the epidural space near the spinal cord
• Spinal injection — Into the spinal fluid (subarachnoid space)
• Peripheral nerve block — Around specific nerves, often guided by ultrasound
• Local infiltration — Directly into tissue at the surgical site
• Dental injection — Near dental nerves for oral procedures

Available Formulations and Concentrations

Bupivacaine comes in several formulations:

• 0.25% solution (with and without preservative)
• 0.5% solution (with and without preservative)
• 0.75% solution (preservative-free only)
• 0.25% and 0.5% with Epinephrine 1:200,000 (Epinephrine helps the anesthetic last longer and reduces bleeding)
• 0.75% in 8.25% dextrose for spinal anesthesia (Marcaine Spinal)
• Liposomal suspension 13.3 mg/mL (Exparel)
• Collagen matrix implant (Xaracoll)

Dosage

Dosing varies significantly by procedure type:

• Peripheral nerve blocks: 25-175 mg per injection
• Epidural: 25-150 mg
• Spinal anesthesia: 7.5-15 mg
• Maximum single dose: 175 mg without Epinephrine; 225 mg with Epinephrine

Your anesthesiologist will determine the exact dose based on the procedure, your body weight, and your overall health.

Who Should Not Receive Bupivacaine?

Bupivacaine should not be used in the following situations:

• Known allergy to Bupivacaine or any amide-type local anesthetic (Lidocaine, Ropivacaine, Mepivacaine)
• Obstetrical paracervical block — Bupivacaine is not approved for this use
• Intravenous regional anesthesia (Bier block) — Due to the risk of cardiac arrest if the tourniquet fails
• 0.75% concentration in obstetrical anesthesia — This carries a boxed warning due to reports of cardiac arrest and death

Your doctor should also use caution if you:

• Have liver disease (Bupivacaine is metabolized by the liver)
• Have heart disease or cardiac rhythm problems
• Are elderly or debilitated
• Are taking certain medications that interact with Bupivacaine

For a full list of side effects and when to seek help, see our guide on Bupivacaine side effects.

How Much Does Bupivacaine Cost?

The cost of Bupivacaine depends on the formulation:

• Generic Bupivacaine injection: $5-$40 per vial (as low as $1.83 per vial with discount coupons)
• Multi-packs of preservative-free vials: $90-$545
• Exparel (liposomal): $285-$365 per vial

In most cases, you won't pay for Bupivacaine separately. It's typically billed as part of your surgical or procedural costs and covered under your medical benefit (not your pharmacy benefit). This means it's subject to your procedure copay and deductible, not a separate prescription cost.

Prior authorization is generally not required for standard generic Bupivacaine, though Exparel may need prior authorization depending on your insurance plan.

For more ways to reduce costs, check out our article on saving money on Bupivacaine.

Current Availability

As of 2026, Bupivacaine remains on the FDA drug shortage list (active since June 2023). Multiple concentrations and formulations are on backorder or in limited supply. The FDA has authorized temporary importation from foreign manufacturers to help meet demand.

If you're scheduled for a procedure, ask your provider about Bupivacaine availability and whether alternative anesthetics may be used.

Final Thoughts

Bupivacaine is a cornerstone of modern anesthesia — a long-acting local anesthetic that enables pain-free surgeries, comfortable labor and deliveries, and effective pain management. While it's always administered by healthcare professionals (so you won't be picking it up at a pharmacy), understanding what it is, how it works, and what to expect can help you feel more prepared for your procedure.

Have questions about Bupivacaine availability in your area? Medfinder can help you check stock and find the care you need.