Bupivacaine, marketed under the brand name Marcaine among others, is a medication used to decrease sensation in a specific small area.

[5][6] Possible side effects include sleepiness, muscle twitching, ringing in the ears, changes in vision, low blood pressure, and an irregular heart rate.

[5][9] An implantable formulation of bupivacaine (Xaracoll) was approved for medical use in the United States in August 2020.

[16][17] The fixed-dose combination of bupivacaine with Type I collagen (brand name Xaracoll) is indicated for acute postsurgical analgesia (pain relief) for up to 24 hours in adults following open inguinal hernia repair.

Effects on the central nervous system typically occur at lower blood plasma concentrations.

Initially, cortical inhibitory pathways are selectively inhibited, causing symptoms of neuronal excitation.

At higher plasma concentrations, both inhibitory and excitatory pathways are inhibited, causing central nervous system depression and potentially coma.

[19] Bupivacaine has caused several deaths when the epidural anaesthetic has been administered intravenously accidentally.

[22] Animal evidence[23][24] indicates intralipid, a commonly available intravenous lipid emulsion, can be effective in treating severe cardiotoxicity secondary to local anaesthetic overdose, and human case reports of successful use in this way.

[19] Bupivacaine is toxic to cartilage and its intra-articular infusions may lead to postarthroscopic glenohumeral chondrolysis.

Unlike lidocaine, the terminal amino portion of bupivacaine (as well as mepivacaine, ropivacaine, and levobupivacaine) is contained within a piperidine ring; these agents are known as pipecholyl xylidines.