Lidocaine and bupivacaine, the local anesthetics that stay on FDA's shortage list

Lidocaine hydrochloride injection, the numbing drug used for everything from stitches to heart rhythm emergencies, has been on FDA's drug shortage list since Feb. 22, 2012. On Nov. 3, 2026, FDA's shortage records¹ listed 65 separate lidocaine injection presentations as currently in shortage, each a specific strength, vial or syringe, with 19 of them marked unavailable.

Bupivacaine, the longer-acting local anesthetic used in spinal anesthesia for cesarean deliveries and in nerve blocks, joined the list on Feb. 20, 2018. Neither drug has come off since. FDA's records¹ show 57 bupivacaine presentations in shortage and five more flagged for discontinuation in May 2026.

Local anesthetics are some of the oldest and cheapest drugs in a hospital, and some of the most heavily used. Together with their combinations and ropivacaine, these drugs account for five of the 69 entries on FDA's current list.

What the shortage list shows

GxRadar pulled FDA's shortage records for the local anesthetics through the openFDA interface. The table counts presentations, the strength-and-package listings FDA tracks individually.

Source: GxRadar analysis of openFDA drug shortage records retrieved Nov. 3, 2026. First-posted date is the earliest among a drug's presentations; later presentations were added in 2016, 2017, 2018 and 2020. Lidocaine and bupivacaine also have two and five presentations, respectively, listed as to be discontinued.

Most presentations carry no stated reason. Where FDA gives one for lidocaine, it is usually "Demand increase for the drug," cited for 15 presentations. A 2023 practice advisory from the Spine Intervention Society⁸, summarizing FDA's information at the time, said the lidocaine shortage was due to "increased demand, manufacturing delays, and discontinuation of specific mixtures," and the bupivacaine shortage to "manufacturing delays, shortage of active ingredients, and increased demand."

The ages put these drugs near the top of GxRadar's list of the longest-running drug shortages. Lidocaine and lidocaine with epinephrine have been listed for about 14.7 years, bupivacaine for 8.7 and ropivacaine for 8.6, against a median of about 4.7 years for the current list as a whole (see how long drug shortages last). Supplier notes on the lidocaine with epinephrine entry give a next delivery of January 2027 and an estimated recovery of March 2027, citing a manufacturing delay.

A listing does not mean the shelves are empty. FDA's FAQ² defines a shortage as a period when national demand "exceeds the supply of the drug." Many presentations are marked available, which can mean a hospital gets some vial sizes and not others, or gets them late.

How the shortages played out in hospitals

The bupivacaine listing in 2018 hit obstetric anesthesia first. An editorial in the AANA Journal¹⁰ that August said facilities across North America were "experiencing a shortage of several formulations of bupivacaine affecting analgesia and anesthesia care, particularly for obstetric services." A case series in A&A Practice⁹ described how one academic hospital retrieved, restricted and reallocated its remaining 0.75% hyperbaric bupivacaine, the formulation routinely used for spinal anesthesia in cesarean delivery, during the 2018 shortage. Cesareans went ahead without delays or a rise in general anesthesia, the authors reported, but trainees had fewer chances to perform spinal anesthesia.

By 2022 the squeeze had spread to lidocaine vials. The Spine Intervention Society advisory⁸ said shortages that year included bupivacaine 0.25% and 0.5% and lidocaine 1%, 2% and 4%, and that in some areas lidocaine "was not available in single-dose vials." Its recommendations for interventional pain doctors, endorsed by seven other medical societies, included that only pharmacists repackage local anesthetic vials for more than one patient, under sterile conditions, and that 0.5% lidocaine "may be as effective as 1%" for some skin numbing. Those are professional practice standards for clinicians; questions about a specific procedure belong with the clinician performing it.

FDA's stopgaps

FDA cannot order a company to make more of a drug, one of the limits described in How FDA works to prevent drug shortages. Its FAQ² says plainly that "FDA can't require firms to increase production." What it can do is bring in supply from abroad, extend expiration dates when stability data support it, and speed reviews for firms that want to add capacity.

For bupivacaine it has used the first two. In a letter dated June 21, 2019⁴, posted on FDA's site, a US company said it was coordinating with FDA to import 0.25% and 0.5% bupivacaine ampules made in Italy, a product "FDA has not approved." The imported cartons were labeled "2,5 mg/mL," with a European decimal comma, rather than as a percentage, and the letter warned that the barcode "may not register with U.S. scanning systems." A nearly identical letter dated April 21, 2023⁵ announced the same arrangement again. GxRadar's explainer on drug importation under section 804 covers the separate, formal importation program.

FDA's current list of extended use dates³ includes six lots of 0.75% spinal bupivacaine in dextrose, with labeled expiration dates from October 2025 to February 2026 each extended by one year. FDA says the extensions are "based on stability data provided by the manufacturers and reviewed by FDA," and that it expects the lots to be replaced once new product is available. Our article on drug expiration dates explains how those dates are set in the first place.

Why injectable anesthetics are vulnerable

FDA's FAQ² gives the short version. "With fewer firms making older sterile injectable drugs, there are a limited number of production lines that can make these drugs," it says, and "when one company has a problem or discontinues its production, it can be difficult for the remaining firms to increase production quickly."

FDA's 2019 report on root causes⁶ supplies the numbers. Of 163 drugs that went into shortage from 2013 to 2017, 63 percent were sterile injectables and 67 percent had a generic version. In the year before the shortage, the median price per unit was $11.05 for the injectables. Expanding or modernizing a plant can take a year or more and cost more than $100 million, the report said, and sterile injectable makers "must also invest in highly specialized equipment."

Source: FDA, Drug Shortages: Root Causes and Potential Solutions (2019)⁶. Survey figures are from a practitioner survey cited in the report.

Local anesthetics fit that profile closely. They are decades old, sold mostly as generics, and made as sterile solutions in vials, ampules and syringes, each a separate presentation that can go short on its own. GxRadar's Why sterile injectables dominate shortage lists and The economics of making a generic go further into the economics, and our piece on group purchasing covers how hospitals buy them.

What comes next

FDA's report to Congress for 2025⁷ says shortages "often persist due to market conditions, which include lack of incentives for firms to manufacture older, less profitable products." That sentence describes the local anesthetics well. The near-term dates to watch are on the lidocaine with epinephrine listing, where suppliers expect deliveries in January 2027, and on FDA's extended use list, where the last bupivacaine lots now run to February 2027. Our shortage tracker updates the listings from FDA data.