What is bupivacaine used for?

• A. Topical skin anesthesia
• B. Intra-articular injection
• C. Nerve block, spinal and epidural
• D. Oral analgesia

Answer: (C)

Bupivacaine is a long-acting amide local anesthetic that works by blocking voltage-gated sodium channels in nerve membranes, stopping nerve impulse conduction. Its potency and slow dissociation give it a prolonged duration of anesthesia, which is ideal for regional techniques. The main clinical uses are nerve blocks and neuraxial anesthesia—spinal and epidural—where it provides intraoperative anesthesia and extended postoperative analgesia, commonly including obstetric epidurals for labor. It’s not typically used for straightforward topical skin anesthesia or for oral analgesia, and while intra-articular use is possible, the most recognized and tested role is in regional and neuraxial anesthesia. Be mindful of its cardiotoxicity risk with high systemic levels, which is managed by careful dosing and sometimes adding epinephrine to limit systemic absorption.