• No supplies of UK-licensed Marcain Heavy 0.5 per cent likely available until 22 July
  • Drug used in caesarean sections, knee and hip replacements, fractured neck of femur operations, and urology and gynaecology procedures
  • Trusts instructed to make decisions about areas where it would be clinically safe to use alternatives

A drug used in most caesarean sections in the UK is expected to be unavailable for the next two weeks, prompting concerns some trusts may run out of supplies.

According to a Department of Health and Social Care alert, published last week, a “short-term supply issue” means no supplies of UK-licensed Marcain Heavy 0.5 per cent are likely to be available until 22 July.

Bupivacaine hydrochloride anhydrous – the drug which comprises Marcain Heavy 0.5 per cent – is used in spinal anaesthesia for caesarean sections as well as a range of other operations, including knee and hip replacements and fractured neck of femur, and urology and gynaecology procedures. It is fast acting – important for emergency caesareans – and offers control over how much of the spinal column is affected, reducing the risks of respiratory depression and other complications.

The sole UK-licensed supplier for Marcain Heavy 0.5 per cent is Aspen, a South African based company, and there are no supplies at wholesalers.

A supply disruption alert said trusts should make decisions about which clinical areas could safely use alternatives to Marcain Heavy, and that existing supplies should be reserved for areas which could not use these, especially obstetrics. 

It added that trusts with excess stocks should share these with other local hospitals but trusts might need to consider using unlicensed supplies of the same drug, which may be available this week from Sweden and Denmark.

“[Marcain Heavy 0.5 per cent] has distinct advantages and is the drug used for most spinal anaesthesia in the UK,” said David Bogod, an anaesthetist at Nottingham University Hospitals Trust and a Royal College of Anaesthetists council member.

“In my own trust we have stocks that we think will last for a month – or longer if they are prioritised to areas like obstetrics. But the situation will vary around the country.”

Dr Bogod said plain bupivacaine could be used as an alternative, although it is not licenced for use in spinal injections. He added few anaesthetists had experience of using it, so there might be anxiety about achieving the “right” impact and the potential of having to convert to a general anaesthetic if this was not successful.

A DHSC spokesperson said: “We are aware of delays in the manufacturing process of the Marcain Heavy injection and we are working closely with NHS England and clinical experts – patients continue to be treated effectively during this time.

“New supplies are expected within the coming weeks and we aim to resolve the situation as quickly as possible.”

HSJ has approached Aspen’s UK office for comment.