Bupivacaine

• Epidural labour analgesia
• Spinal anaesthesia for LSCS
• Perineal infiltration

Voltage-gated Na⁺ channel blockade in the inactivated state → conduction block; highly cardiotoxic if IV.

• Intralipid 20% for LAST — 1.5 mL/kg bolus then 0.25 mL/kg/min
• Test dose before top-up (adrenaline)
• Levobupivacaine preferred (less cardiotoxic)

Spinal LSCS

Heavy 0.5% 2–2.5 mL + fentanyl 15–25 μg

Epidural labour bolus

0.1–0.125% 10–15 mL ± fentanyl 2 μg/mL

Max local infiltration

2 mg/kg plain, 2.5 mg/kg with adrenaline

• AbsoluteCoagulopathy (neuraxial)
• AbsoluteLocal infection at injection site
• AbsoluteRaised ICP

• LAST — perioral numbness → seizures → cardiac arrest
• Hypotension (sympathetic block)
• Total spinal (over-dose or unrecognised subarachnoid)
• Post-dural puncture headache

• • Highly protein-bound → minimal placental transfer at clinical doses

• Class I/III antiarrhythmics

  Avoid

  Additive cardiac toxicity

• 💡 Practise the LAST rescue algorithm annually — Intralipid at every neuraxial site
• 💡 Use ultrasound and test doses to minimise accidental IV