Active Ingredient: Bupivacaine
For this indication, competent medicine agencies globally authorize below treatments:
Peridural
5 - 175 mg
From 5 To 175 mg once every day
The following table is a guide to dosage for the more commonly used techniques in the average adult. The figures reflect the expected average dose range needed. Standard textbooks should be consulted for factors affecting specific block techniques and for individual patient requirements.
N.B. When prolonged blocks are used, either by continuous infusion or by repeated bolus administration, the risks of reaching a toxic plasma concentration or inducing a local neural injury must be considered.
The clinician’s experience and knowledge of the patient’s physical status is important in calculating the required dose. The lowest dose required for adequate anaesthesia should be used. Individual variations in onset and duration occur.
Dosage recommendations for adults:
| Surgical anaesthesia | Conc mg/ml | Volume ml | Dose mg | Onset min | Duration of effect hours7 |
|---|---|---|---|---|---|
| Major Nerve Block2 | |||||
| (e.g. brachial plexus, femoral, sciatic) | 5.0 | 10-35 | 50-175 | 15-30 | 4-8 |
2 The dose for a major nerve block must be adjusted according to site of administration and patient status. Interscalene and supraclavicular brachial plexus blocks may be associated with a higher frequency of serious adverse reactions, regardless of the local anaesthetic used.
In general, surgical anaesthesia (e.g. epidural administration) requires the use of higher concentrations and doses. When a less intense block is required (e.g. in the relief of labour pain), the use of a lower concentration is indicated. The volume of drug used will affect the extent of spread of anaesthesia.
In order to avoid intravascular injection, aspiration should be repeated prior to and during administration of the main dose, which should be injected slowly or in incremental doses, at a rate of 25-50 mg/min, while closely observing the patient’s vital functions and maintaining verbal contact. An inadvertent intravascular injection may be recognised by a temporary increase in heart rate and an accidental intrathecal injection by signs of a spinal block. If toxic symptoms occur, the injection should be stopped immediately.
Experience to date indicates that 400 mg administered over 24 hours is well tolerated in the average adult.
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