Bupivacaine vs. Lidocaine: A Pharmacist Explains What You Need to Know

Bupivacaine(brand name Marcaine) and lidocaine (brand name Xylocaine) are common local anesthetics. They can numb parts of the body before a medical procedure and prevent and manage pain during surgery and recovery.

Local anesthetics are different from general anesthetics, which cause a person to fall asleep.

What Are Bupivacaine and Lidocaine?

Buvicaine and lidocaine may both be used to numb pain for medical and dental procedures. However, they also have several key differences.

Your healthcare provider will consider several factors when choosing the appropriate anesthetic for your procedure.

Benefits of Bupivacaine vs. Lidocaine

Though bupivacaine and lidocaine have many similarities, there are some differences between them. These distinctions often dictate which one is preferred in clinical scenarios. Keep in mind that anesthesia is often not an either/or situation.

The following table provides a quick comparison of these two medicines:

Bupivacaine vs. LidocaineDrug ClassDosage FormsUsesHow Quickly It WorksHow Long It LastsBupivacaineAmide local anestheticInjection, implantInjection: dental procedures,surgeries,labor and delivery,epidurals, spinal anesthesia. Implant: hernia repair surgeryInjection: 2 to 10 minutes.Injection: 2 to 4 hours.Implant: 24 hoursLidocaineAmide local anestheticInjection, topical jelly, patch, creamInjection: surgeries, tooth extractions,heart arrhythmias.Jelly: urological procedures, intubation (inserting a tube into the airway).Patch: post-herpetic neuralgia (pain after shingles)Injection: less than 2 minutesInjection: 1 to 2 hours.Patch: 12 hours.Potential Side Effects and RisksThere are some significant risks to keep in mind if you use a local anesthesia medicine like bupivacaine or lidocaine. These include side effects, drug interactions, and precautions. As with any medicine, discussing the risks and benefits with your healthcare provider to optimize your health and safety is essential. These can include:Common side effects:Common side effects of lidocaine include mouth numbness, dizziness, and slow or slurred speech.Anytime anesthetics are used to numb the mouth or throat, there is a risk that swallowing can become impaired. If you are givenlidocaine, be sure towait at least an hour before eatingto minimize the chance of choking or aspirating (food or drinks entering the airway).If you are givenbupivacaine, you’ll need towait at least seven hoursbefore eating or drinking to be sure the medicine is safely out of your system.Rare but serious risks:There are some specific side effects to monitor for after administration of either bupivacaine or lidocaine. Signs of a rare but life-threatening complication calledmethemoglobinemiainclude pale or blue skin, headache, a fast heart rate, shortness of breath, feeling faint, or fatigue.These symptoms can occur during an injection or several hours afterward, so seek emergency help right away if they happen when you’re at home.Other signs of toxicity (high levels of medicine in the bloodstream) include muscle spasms, seizures, slow or shallow breathing, heart failure, or coma.Bupivacaineis more likely to causeheart problems.Signs of toxicity to the heart include low blood pressure, slow heart rate, and irregular heartbeat.Interactions:Local anesthetics like bupivacaine and lidocaine can interact with medications that cause drowsiness, such as opioids, sleep aids, and benzodiazepines, potentially leading to dangerous breathing issues.Bupivacaine and lidocaine may also interact withepinephrine, causing dangerous blood pressure spikes when combined with certain drugs, including tricyclic antidepressants, monoamine oxidase inhibitors, ergot drugs, or vasoconstrictors like phenylephrine. Some antipsychotics can reverse epinephrine’s effects.Additionally, lidocaine may interact with heart rhythm medications,while Zynrelef (bupivacaine) can interact with blood pressure meds, diuretics, blood thinners, and certain antidepressants.Who should avoid them?:People withhypersensitivity reactions(severe allergic reactions) to other amide local anesthetics should avoid bupivacaine and lidocaine.Bupivacaine is contraindicated in (should not be used for)paracervical block anesthesiaduring labor. This is because it may cause a slow heart rate or the death of the fetus.Children under 12 shouldn’t use bupivacaine. It is approved for adults and children 12 years old and up.SummaryBupivacaine and lidocaine are local anesthetics used to dull pain during medical or dental procedures.Bupivacaine takes a little longer than lidocaine to kick in and lasts longer. It is ideal for controlling pain for an extended period but is more likely to cause toxicity.Lidocaine starts acting quickly and also wears off faster than bupivacaine.Both medicines have common side effects, including numbness, dizziness, and slowed speech. Rare but serious side effects include seizures, shallow breathing, and slow heart rate.Local anesthetics can interact with other medicines that cause drowsiness or slow breathing. Additionally, lidocaine and bupivacaine may be combined with epinephrine, which can interact with some antidepressants.Be sure to discuss any concerns you have about anesthesia with your healthcare provider before your procedure and contact them promptly if you experience any problematic side effects.

Potential Side Effects and Risks

There are some significant risks to keep in mind if you use a local anesthesia medicine like bupivacaine or lidocaine. These include side effects, drug interactions, and precautions. As with any medicine, discussing the risks and benefits with your healthcare provider to optimize your health and safety is essential. These can include:

Summary

Bupivacaine and lidocaine are local anesthetics used to dull pain during medical or dental procedures.

Bupivacaine takes a little longer than lidocaine to kick in and lasts longer. It is ideal for controlling pain for an extended period but is more likely to cause toxicity.

Lidocaine starts acting quickly and also wears off faster than bupivacaine.

Both medicines have common side effects, including numbness, dizziness, and slowed speech. Rare but serious side effects include seizures, shallow breathing, and slow heart rate.

Local anesthetics can interact with other medicines that cause drowsiness or slow breathing. Additionally, lidocaine and bupivacaine may be combined with epinephrine, which can interact with some antidepressants.

Be sure to discuss any concerns you have about anesthesia with your healthcare provider before your procedure and contact them promptly if you experience any problematic side effects.

17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Van Boxstael S, Lopez AM, Balocco AL, et al.Effect of lidocaine 2% versus bupivacaine 0.5% and 1 versus 2 dual separate injections on onset and duration of ultrasound-guided wrist blocks: a blinded 2 × 2 factorial randomized clinical trial.Anesth Analg. 2022;134(6):1318-1325. doi:10.1213/ANE.0000000000005936Paganelli MA, Popescu GK.Actions of bupivacaine, a widely used local anesthetic, on NMDA receptor responses.J Neurosci. 2015;35(2):831-842. doi:10.1523/JNEUROSCI.3578-14.2015Bahar E, Yoon H.Lidocaine: a local anesthetic, its adverse effects and management.Medicina (Kaunas). 2021;57(8):782. Published 2021 Jul 30. doi:10.3390/medicina57080782Balakrishnan K, Ebenezer V, Dakir A, et al.Bupivacaine versus lignocaine as the choice of local anesthetic agent for impacted third molar surgery: a review.J Pharm Bioallied Sci. 2015;7(Suppl 1):S230-S233. doi:10.4103/0975-7406.155921U.S. Food and Drug Administration.Bupivacaine hydrochloride injection, USP.Collins JB, Song J, Mahabir RC.Onset and duration of intradermal mixtures of bupivacaine and lidocaine with epinephrine.Can J Plast Surg. 2013;21(1):51-53. doi:10.1177/229255031302100112Lee IWS, Schraag S.The use of intravenous lidocaine in perioperative medicine: anaesthetic, analgesic and immune-modulatory aspects.J Clin Med. 2022;11(12):3543. Published 2022 Jun 20. doi:10.3390/jcm11123543Su N, Wang H, Zhang S, et al.Efficacy and safety of bupivacaineversuslidocaine in dental treatments: a meta-analysis of randomised controlled trials.Int Dent J. 2014;64(1):34-45. doi:10.1111/idj.12060U.S. Food and Drug Administration.XARACOLL® (bupivacaine hydrochloride) implant prescribing information.U.S. Food and Drug Administration.ZYNRELEF™ (bupivacaine and meloxicam) extended-release solution.Karnina R, Arif SK, Hatta M, et al.Molecular mechanisms of lidocaine.Ann Med Surg (Lond). 2021;69:102733. Published 2021 Aug 17. doi:10.1016/j.amsu.2021.102733U.S. Food and Drug Administration.Xylocaine® 2% jelly (lidocaine hydrochloride) prescribing information.U.S. Food and Drug Administration.Xylocaine (lidocaine HCl injection, USP).Voute M, Morel V, Pickering G.Topical lidocaine for chronic pain treatment.Drug Des Devel Ther. 2021;15:4091-4103. Published 2021 Sep 29. doi:10.2147/DDDT.S328228U.S. Food and Drug Administration.Lidoderm (lidocaine patch 5%) prescribing information.Golzari SE, Soleimanpour H, Mahmoodpoor A, et al.Lidocaine and pain management in the emergency department: a review article.Anesth Pain Med. 2014;4(1):e15444. Published 2014 Feb 15. doi:10.5812/aapm.15444Becker DE, Reed KL.Local anesthetics: review of pharmacological considerations.Anesth Prog. 2012;59(2):90-103. doi:10.2344/0003-3006-59.2.90

17 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Van Boxstael S, Lopez AM, Balocco AL, et al.Effect of lidocaine 2% versus bupivacaine 0.5% and 1 versus 2 dual separate injections on onset and duration of ultrasound-guided wrist blocks: a blinded 2 × 2 factorial randomized clinical trial.Anesth Analg. 2022;134(6):1318-1325. doi:10.1213/ANE.0000000000005936Paganelli MA, Popescu GK.Actions of bupivacaine, a widely used local anesthetic, on NMDA receptor responses.J Neurosci. 2015;35(2):831-842. doi:10.1523/JNEUROSCI.3578-14.2015Bahar E, Yoon H.Lidocaine: a local anesthetic, its adverse effects and management.Medicina (Kaunas). 2021;57(8):782. Published 2021 Jul 30. doi:10.3390/medicina57080782Balakrishnan K, Ebenezer V, Dakir A, et al.Bupivacaine versus lignocaine as the choice of local anesthetic agent for impacted third molar surgery: a review.J Pharm Bioallied Sci. 2015;7(Suppl 1):S230-S233. doi:10.4103/0975-7406.155921U.S. Food and Drug Administration.Bupivacaine hydrochloride injection, USP.Collins JB, Song J, Mahabir RC.Onset and duration of intradermal mixtures of bupivacaine and lidocaine with epinephrine.Can J Plast Surg. 2013;21(1):51-53. doi:10.1177/229255031302100112Lee IWS, Schraag S.The use of intravenous lidocaine in perioperative medicine: anaesthetic, analgesic and immune-modulatory aspects.J Clin Med. 2022;11(12):3543. Published 2022 Jun 20. doi:10.3390/jcm11123543Su N, Wang H, Zhang S, et al.Efficacy and safety of bupivacaineversuslidocaine in dental treatments: a meta-analysis of randomised controlled trials.Int Dent J. 2014;64(1):34-45. doi:10.1111/idj.12060U.S. Food and Drug Administration.XARACOLL® (bupivacaine hydrochloride) implant prescribing information.U.S. Food and Drug Administration.ZYNRELEF™ (bupivacaine and meloxicam) extended-release solution.Karnina R, Arif SK, Hatta M, et al.Molecular mechanisms of lidocaine.Ann Med Surg (Lond). 2021;69:102733. Published 2021 Aug 17. doi:10.1016/j.amsu.2021.102733U.S. Food and Drug Administration.Xylocaine® 2% jelly (lidocaine hydrochloride) prescribing information.U.S. Food and Drug Administration.Xylocaine (lidocaine HCl injection, USP).Voute M, Morel V, Pickering G.Topical lidocaine for chronic pain treatment.Drug Des Devel Ther. 2021;15:4091-4103. Published 2021 Sep 29. doi:10.2147/DDDT.S328228U.S. Food and Drug Administration.Lidoderm (lidocaine patch 5%) prescribing information.Golzari SE, Soleimanpour H, Mahmoodpoor A, et al.Lidocaine and pain management in the emergency department: a review article.Anesth Pain Med. 2014;4(1):e15444. Published 2014 Feb 15. doi:10.5812/aapm.15444Becker DE, Reed KL.Local anesthetics: review of pharmacological considerations.Anesth Prog. 2012;59(2):90-103. doi:10.2344/0003-3006-59.2.90

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Van Boxstael S, Lopez AM, Balocco AL, et al.Effect of lidocaine 2% versus bupivacaine 0.5% and 1 versus 2 dual separate injections on onset and duration of ultrasound-guided wrist blocks: a blinded 2 × 2 factorial randomized clinical trial.Anesth Analg. 2022;134(6):1318-1325. doi:10.1213/ANE.0000000000005936Paganelli MA, Popescu GK.Actions of bupivacaine, a widely used local anesthetic, on NMDA receptor responses.J Neurosci. 2015;35(2):831-842. doi:10.1523/JNEUROSCI.3578-14.2015Bahar E, Yoon H.Lidocaine: a local anesthetic, its adverse effects and management.Medicina (Kaunas). 2021;57(8):782. Published 2021 Jul 30. doi:10.3390/medicina57080782Balakrishnan K, Ebenezer V, Dakir A, et al.Bupivacaine versus lignocaine as the choice of local anesthetic agent for impacted third molar surgery: a review.J Pharm Bioallied Sci. 2015;7(Suppl 1):S230-S233. doi:10.4103/0975-7406.155921U.S. Food and Drug Administration.Bupivacaine hydrochloride injection, USP.Collins JB, Song J, Mahabir RC.Onset and duration of intradermal mixtures of bupivacaine and lidocaine with epinephrine.Can J Plast Surg. 2013;21(1):51-53. doi:10.1177/229255031302100112Lee IWS, Schraag S.The use of intravenous lidocaine in perioperative medicine: anaesthetic, analgesic and immune-modulatory aspects.J Clin Med. 2022;11(12):3543. Published 2022 Jun 20. doi:10.3390/jcm11123543Su N, Wang H, Zhang S, et al.Efficacy and safety of bupivacaineversuslidocaine in dental treatments: a meta-analysis of randomised controlled trials.Int Dent J. 2014;64(1):34-45. doi:10.1111/idj.12060U.S. Food and Drug Administration.XARACOLL® (bupivacaine hydrochloride) implant prescribing information.U.S. Food and Drug Administration.ZYNRELEF™ (bupivacaine and meloxicam) extended-release solution.Karnina R, Arif SK, Hatta M, et al.Molecular mechanisms of lidocaine.Ann Med Surg (Lond). 2021;69:102733. Published 2021 Aug 17. doi:10.1016/j.amsu.2021.102733U.S. Food and Drug Administration.Xylocaine® 2% jelly (lidocaine hydrochloride) prescribing information.U.S. Food and Drug Administration.Xylocaine (lidocaine HCl injection, USP).Voute M, Morel V, Pickering G.Topical lidocaine for chronic pain treatment.Drug Des Devel Ther. 2021;15:4091-4103. Published 2021 Sep 29. doi:10.2147/DDDT.S328228U.S. Food and Drug Administration.Lidoderm (lidocaine patch 5%) prescribing information.Golzari SE, Soleimanpour H, Mahmoodpoor A, et al.Lidocaine and pain management in the emergency department: a review article.Anesth Pain Med. 2014;4(1):e15444. Published 2014 Feb 15. doi:10.5812/aapm.15444Becker DE, Reed KL.Local anesthetics: review of pharmacological considerations.Anesth Prog. 2012;59(2):90-103. doi:10.2344/0003-3006-59.2.90

Van Boxstael S, Lopez AM, Balocco AL, et al.Effect of lidocaine 2% versus bupivacaine 0.5% and 1 versus 2 dual separate injections on onset and duration of ultrasound-guided wrist blocks: a blinded 2 × 2 factorial randomized clinical trial.Anesth Analg. 2022;134(6):1318-1325. doi:10.1213/ANE.0000000000005936

Paganelli MA, Popescu GK.Actions of bupivacaine, a widely used local anesthetic, on NMDA receptor responses.J Neurosci. 2015;35(2):831-842. doi:10.1523/JNEUROSCI.3578-14.2015

Bahar E, Yoon H.Lidocaine: a local anesthetic, its adverse effects and management.Medicina (Kaunas). 2021;57(8):782. Published 2021 Jul 30. doi:10.3390/medicina57080782

Balakrishnan K, Ebenezer V, Dakir A, et al.Bupivacaine versus lignocaine as the choice of local anesthetic agent for impacted third molar surgery: a review.J Pharm Bioallied Sci. 2015;7(Suppl 1):S230-S233. doi:10.4103/0975-7406.155921

U.S. Food and Drug Administration.Bupivacaine hydrochloride injection, USP.

Collins JB, Song J, Mahabir RC.Onset and duration of intradermal mixtures of bupivacaine and lidocaine with epinephrine.Can J Plast Surg. 2013;21(1):51-53. doi:10.1177/229255031302100112

Lee IWS, Schraag S.The use of intravenous lidocaine in perioperative medicine: anaesthetic, analgesic and immune-modulatory aspects.J Clin Med. 2022;11(12):3543. Published 2022 Jun 20. doi:10.3390/jcm11123543

Su N, Wang H, Zhang S, et al.Efficacy and safety of bupivacaineversuslidocaine in dental treatments: a meta-analysis of randomised controlled trials.Int Dent J. 2014;64(1):34-45. doi:10.1111/idj.12060

U.S. Food and Drug Administration.XARACOLL® (bupivacaine hydrochloride) implant prescribing information.

U.S. Food and Drug Administration.ZYNRELEF™ (bupivacaine and meloxicam) extended-release solution.

Karnina R, Arif SK, Hatta M, et al.Molecular mechanisms of lidocaine.Ann Med Surg (Lond). 2021;69:102733. Published 2021 Aug 17. doi:10.1016/j.amsu.2021.102733

U.S. Food and Drug Administration.Xylocaine® 2% jelly (lidocaine hydrochloride) prescribing information.

U.S. Food and Drug Administration.Xylocaine (lidocaine HCl injection, USP).

Voute M, Morel V, Pickering G.Topical lidocaine for chronic pain treatment.Drug Des Devel Ther. 2021;15:4091-4103. Published 2021 Sep 29. doi:10.2147/DDDT.S328228

U.S. Food and Drug Administration.Lidoderm (lidocaine patch 5%) prescribing information.

Golzari SE, Soleimanpour H, Mahmoodpoor A, et al.Lidocaine and pain management in the emergency department: a review article.Anesth Pain Med. 2014;4(1):e15444. Published 2014 Feb 15. doi:10.5812/aapm.15444

Becker DE, Reed KL.Local anesthetics: review of pharmacological considerations.Anesth Prog. 2012;59(2):90-103. doi:10.2344/0003-3006-59.2.90

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