Active Ingredient: Bupivacaine
For this indication, competent medicine agencies globally authorize below treatments:
Peridural
0.5 - 2 mg per kg of body weight
From 0.5 To 2 mg per kg of body weight once every day
Paediatric regional anaesthetic procedures should be performed by qualified clinicians who are familiar with this population and the technique.
The doses in the table should be regarded as guidelines for use in paediatrics. Individual variations occur. In children with a high body weight a gradual reduction of the dosage is often necessary and should be based on the ideal body weight. Standard textbooks should be consulted for factors affecting specific block techniques and for individual patient requirements.
The lowest dose required for adequate analgesia should be used.
Dosage recommendations for children 1 to 12 years of age:
| Conc. mg/ml | Volume ml/kg | Dose mg/kg | Onset min | Duration of effect hours | |
|---|---|---|---|---|---|
| Acute pain management (per- and postoperative) | |||||
| Caudal Epidural Administration | 2.5 | 0.6-0.8 | 1.5-2 | 20-30 | 2-6 |
| Lumbar Epidural Administration | 2.5 | 0.6-0.8 | 1.5-2 | 20-30 | 2-6 |
| Thoracic Epidural Administrationa | 2.5 | 0.6-0.8 | 1.5-2 | 20-30 | 2-6 |
| Field Block (e.g. minor nerve blocks and infiltration) | 2.5 | 0.5-2.0 | |||
| 5.0 | 0.5-2.0 | ||||
| Peripheral Nerve Blocks (e.g. ilioinguinal – iliohypogastric) | 2.5 | 0.5-2.0b | |||
| 5.0 | 0.5-2.0b | ||||
a Thoracic epidural blocks need to be given by incremental dosage until the desired level of anaesthesia is achieved.
b The onset and duration of peripheral nerve blocks depend on the type of block and the dose administered.
In children the dosage should be calculated on a weight basis up to 2 mg/kg.
In order to avoid intravascular injection, aspiration should be repeated prior to and during administration of the main dose. This should be injected slowly in incremental doses, particularly in the lumbar and thoracic epidural routes, constantly and closely observing the patient’s vital functions.
Peritonsillar infiltration has been performed in children above 2 years of age with bupivacaine 2.5 mg/ml at a dose of 7.5-12.5 mg per tonsil.
Ilioinguinal-iliohypogastric blocks have been performed in children aged 1 year or older with bupivacaine 2.5 mg/ml at a dose of 0.1-0.5 ml/kg equivalent to 0.25-1.25 mg/kg. Children aged 5 years or older have received bupivacaine 5 mg/ml at a dose of 1.25-2 mg/kg.
For penile blocks bupivacaine 5 mg/ml has been used at total doses of 0.2-0.5 ml/kg equivalent to 1-2.5 mg/kg.
The safety and efficacy of bupivacaine with and without adrenaline in children aged <1 year of age have not been established. Only limited data are available.
Safety and efficacy of intermittent epidural bolus injection or continuous infusion have not been established. Only limited data is available.
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