Usual Adult Dose for Local Anesthesia

Local Infiltration:
0.25% concentration: Inject up to the maximum dose of 175 mg

Epidural Block:
0.75% concentration: Inject 75 to 150 mg (10 to 20 mL) once for complete motor block; not for obstetrical anesthesia
0.5% concentration: Inject 50 to 100 mg (10 to 20 mL) for moderate to complete motor block; repeat doses increase the degree of motor block
0.25% concentration: Inject 25 to 50 mg (10 to 20 mL) for partial to moderate motor block; repeat doses increase the degree of motor block

Epidural Anesthesia: 0.5% and 0.75% solutions should be administered in 3 to 5 mL increments with sufficient time between doses to detect toxicity or accidental intravascular or intrathecal injection

Epidural Anesthesia in Obstetrics: Only 0.5% and 0.25% concentrations should be used; 0.5% solution should be administered in 3 to 5 mL increments not exceeding 50 to 100 mg at any dosing interval; repeat doses should follow a test dose containing epinephrine if not contraindicated; only preservative-free products should be used

Caudal Block:
0.5% concentration: Inject 75 to 150 mg (15 to 30 mL) for moderate to complete motor block; repeat doses increase the degree of motor block
0.25% concentration: Inject 37.5 to 75 mg (15 to 30 mL) for moderate motor block; repeat doses increase the degree of motor block

Peripheral Nerve Block:
0.5% concentration: Inject 25 mg up to the maximum dose (5 mL up to the maximum dose) for moderate to complete motor block; repeat doses increase the degree of motor block
0.25% concentration: Inject 12.5 mg up to the maximum dose (5 mL up to the maximum dose) for moderate to complete motor block; repeat doses increase the degree of motor block

Retrobulbar Block:
0.75% concentration: Inject 15 to 30 mg (2 to 4 mL) for complete motor block; repeat doses increase the degree of motor block

Sympathetic Block:
0.25% concentration: Inject 50 to 125 mg (20 to 50 mL)

Comments:

• Most experience to date is with single doses up to 175 mg.
• Doses may be repeated up to once every 3 hours; not to exceed 400 mg in 24 hours.
• A test dose should be given prior to caudal and lumbar epidural blocks; the manufacturer product information should be consulted for further information
• These recommendations are to serve as a guide for use in the average adult.
• Standard textbooks should be consulted for specific techniques and procedures.

Uses: For the production of local or regional anesthesia or analgesia for surgery, dental and oral surgery procedures, diagnostic and therapeutic procedures, and for obstetrical procedures (only 0.25% and 0.5% concentrations indicated for obstetrical anesthesia)

Usual Adult Dose for Cesarean Section

7.5 to 10.5 mg (1 to 1.4 mL) of preservative free 0.75% bupivacaine in 8.25% dextrose has been used for Cesarean section under spinal anesthesia

Comments:

• At recommended doses, 0.75% bupivacaine in 8.25% dextrose produces complete motor and sensory block.
• These recommendations are to serve as a guide for use in the average adult.
• Standard textbooks should be consulted to determine accepted procedure and techniques for the administration of spinal anesthesia

Usual Adult Dose for Anesthesia

Spinal Anesthesia for Lower Extremity and Perineal Procedures: 7.5 mg (1 mL) of preservative free 0.75% bupivacaine in 8.25% dextrose has been used

Comments: Procedures include vaginal hysterectomy and transurethral resection of the prostate (TURP).

Spinal Anesthesia for Lower Abdominal Procedures: 12 mg (1.6 mL) of preservative free 0.75% bupivacaine in 8.25% dextrose has been used

Comments:

• Procedures include abdominal hysterectomy, tubal ligation, and appendectomy.
• At recommended doses, 0.75% bupivacaine in 8.25% dextrose produces complete motor and sensory block.
• These recommendations are to serve as a guide for use in the average adult.
• Standard textbooks should be consulted to determine accepted procedure and techniques for the administration of spinal anesthesia.

Usual Pediatric Dose for Local Anesthesia

The following recommendations are for pediatric patients 12 years or older:

Local Infiltration:
0.25% concentration: Inject up to the maximum dose of 175 mg

Epidural Block:
0.75% concentration: Inject 75 to 150 mg (10 to 20 mL) once for complete motor block; not for obstetrical anesthesia
0.5% concentration: Inject 50 to 100 mg (10 to 20 mL) for moderate to complete motor block; repeat doses increase the degree of motor block
0.25% concentration: Inject 25 to 50 mg (10 to 20 mL) for partial to moderate motor block; repeat doses increase the degree of motor block

Epidural Anesthesia: 0.5% and 0.75% solutions should be administered in 3 to 5 mL increments with sufficient time between doses to detect toxicity or accidental intravascular or intrathecal injection

Epidural Anesthesia in Obstetrics: Only 0.5% and 0.25% concentrations should be used; 0.5% solution should be administered in 3 to 5 mL increments not exceeding 50 to 100 mg at any dosing interval; repeat doses should follow a test dose containing epinephrine if not contraindicated; only preservative-free products should be used

Caudal Block:
0.5% concentration: Inject 75 to 150 mg (15 to 30 mL) for moderate to complete motor block; repeat doses increase the degree of motor block
0.25% concentration: Inject 37.5 to 75 mg (15 to 30 mL) for moderate motor block; repeat doses increase the degree of motor block

Peripheral Nerve Block:
0.5% concentration: Inject 25 mg up to the maximum dose (5 mL up to the maximum dose) for moderate to complete motor block; repeat doses increase the degree of motor block
0.25% concentration: Inject 12.5 mg up to the maximum dose (5 mL up to the maximum dose) for moderate to complete motor block; repeat doses increase the degree of motor block

Retrobulbar Block:
0.75% concentration: Inject 15 to 30 mg (2 to 4 mL) for complete motor block; repeat doses increase the degree of motor block

Sympathetic Block:
0.25% concentration: Inject 50 to 125 mg (20 to 50 mL)

Comments:

• Most experience to date is with single doses up to 175 mg.
• Doses may be repeated up to once every 3 hours; not to exceed 400 mg in 24 hours.
• A test dose should be given prior to caudal and lumbar epidural blocks; the manufacturer product information should be consulted for further information
• Standard textbooks should be consulted for specific techniques and procedures.

Uses: For the production of local or regional anesthesia or analgesia for surgery, dental and oral surgery procedures, diagnostic and therapeutic procedures, and for obstetrical procedures (only 0.25% and 0.5% concentrations indicated for obstetrical anesthesia)

Renal Dose Adjustments

• Risk of adverse reactions to this drug may be greater in patients with renal impairment. Monitor closely and use with caution.

Liver Dose Adjustments

• Moderate and Severe hepatic impairment: Consider reducing dosing and increase monitoring for local anesthetic systemic toxicity in these patients. Use with caution.

Dose Adjustments

Doses should be reduced for the elderly and/or debilitated patients and those with cardiac and/or liver disease.

Precautions

US BOXED WARNING:
OBSTETRICAL ANESTHESIA:

• The 0.75% concentration of bupivacaine is not recommended for obstetrical anesthesia. There have been reports of cardiac arrest with difficult resuscitation or death during use of this drug for epidural anesthesia in obstetrical patients. In most cases, this has followed use of the 0.75% concentration. Resuscitation has been difficult or impossible despite apparently adequate preparation and appropriate management. Cardiac arrest has occurred after convulsions resulting from systemic toxicity, presumably following unintentional intravascular injection. The 0.75% concentration should be reserved for surgical procedures where a high degree of muscle relaxation and prolonged effect are necessary.

CONTRAINDICATIONS:

• Known hypersensitivity to the active component, to any of the ingredients, or to any local anesthetic agent of the amide-type
• Obstetrical paracervical block anesthesia
• IV regional anesthesia (Bier's block)

The use of this drug in patients younger than 12 years old is not recommended.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Rapid injection of a large volume of local anesthetic solution should be avoided and fractional/incremental doses should be used when feasible.
• The duration of anesthesia is such that for most indications, a single dose is sufficient.
• Not recommended for use in IV regional anesthesia (Bier Block).
• The manufacturer product information should be consulted.
• Standard textbooks should be consulted for specific techniques and procedures.

Reconstitution/preparation techniques:

• Mixing or intercurrent use of any other local anesthetic with this drug is not recommended because of insufficient data on the clinical use of such mixtures.
• Unused portions of solutions should be discarded.
• Do not use solutions which are discolored or contain particulate matter.
• The manufacturer product information should be consulted.

General:

• The dose of any local anesthetic varies with the anesthetic procedure, area to be anesthetized, vascularity of the tissues, number of neuronal segments to be blocked, depth of anesthesia, degree of muscle relaxation required, duration of anesthesia desired, individual tolerance, and physical condition of the patient.
• The lowest effective dose and concentration required to produce desired result should be used.

Monitoring:

• Cardiovascular and respiratory vital signs should be carefully and constantly monitored.

Patient advice:

• Report any previous allergic reactions to local anesthetics.
• Temporary loss of sensation and motor activity, usually in the lower half of the body, following proper administration of caudal or epidural anesthesia, will occur.
• If you have received a dental injection, avoid chewing solid foods until anesthesia has worn off (up to 7 hours).
• Seek medical attention immediately if you experience: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue.