Indication
Bupivacaine is indicated for the production of local or regional anaesthesia or analgesia for surgery, for oral surgery procedures, for diagnostic and therapeutic procedures, and for obstetrical procedures.
The routes of administration and indicated Bupivacaine concentrations are:
Local infiltration | 0.25% | |
Peripheral nerve block | 0.25%, 0.5% | |
Sympathetic block | 0.25% | |
Lumbar epidural | 0.25%, 0.5% and 0.75% (non-obstetrical) | |
Caudal | 0.25%, 0.5% |
Dosage & Administration
The dose of any local anaesthetic administered varies with the anaesthetic procedure, the area to be anaesthetized, the vascularity of the tissues, the number of neuronal segments to be blocked. In recommended doses, Bupivacaine produces complete sensory block, but the effect on motor function differs among the three concentrations.
0.25% when used for caudal, epidural, or peripheral nerve block, produces incomplete motor block. Should be used for operations in which muscle relaxation is not important, or when another means of providing muscle relaxation is used concurrently. Onset of action may be slower than with the 0.5% or 0.75% solutions.
0.5% provides motor blockade for caudal, epidural, or nerve block, but muscle relaxation may be inadequate for operations in which complete muscle relaxation is essential.
Maximum dosage limit must be individualized in each case after evaluating the size and physical status of the patient, as well as the usual rate of systemic absorption from a particular injection site. Most experience to date is with single doses of Bupivacaine up to 175 mg. These doses may be repeated up to once every three hours. In clinical studies to date, total daily doses up to 400 mg have been reported. Until further experience is gained, this dose should not be exceeded in 24 hours.
The following dosages have generally proved satisfactory and are recommended as a guide for use in the average adult. These dosages should be reduced for young, elderly or debilitated patients.
| Each Dose | ||||||
| Type of Block | Conc. | (mL) | (mg) | |||
| Local Infiltration | 0.25% | up to max. | up to max. | |||
| Epidural | 0.5% | 10-20 | 50-100 | |||
| 0.25% | 10-20 | 25-50 | ||||
| Caudal | 0.5% | 15-30 | 75-150 | |||
| 0.25% | 15-30 | 37.5-75 | ||||
| Peripheral Nerves | 0.5% | 5 to max. | 25 to max. | |||
| 0.25% | 5 to max. | 12.5 to max. | ||||
| Sympathetic | 0.25% | 20-50 | 50-125 |
Precautions
Use in Children
Administration to children under 12 years of age is not recommended until further experience is gained in this group.
