The Obstetric Anaesthetists’ Association has been made aware by its members of a shortage of heavy bupivacaine 0.5% solution. The OAA has been involved in discussions with the Royal College of Anaesthetists and the Association of Anaesthetists about the management of the shortage. The RCoA has put out a statement on the College website (https://www.rcoa.ac.uk/news-and-bulletin/rcoa-news-and-statements/supply-disruption-alert-–-marcain-heavy-05-solution
) which highlights the importance of hospitals prioritising existing stocks of heavy 0.5% bupivacaine for use in obstetric anaesthesia.
In the absence of heavy bupivacaine 0.5% solutions, plain bupivacaine 0.5% solutions can be used as an alternative for spinal anaesthesia but anaesthetists should be aware that for a given dose of local anaesthetic the block characteristics of plain bupivacaine may vary with regards to onset time and height of block compared to the characteristics of heavy bupivacaine 0.5% which are familiar to anaesthetists.
There is a Cochrane Library Systematic review comparing Hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005143.pub3/epdf/full
The supply distribution alert issued by the Department of Health and Social Care has information about alternative supplies of heavy bupivacaine that departments might wish to discuss with their pharmacy and clinical director.