Usual Adult Dose for Local Anesthesia

Lumbar Epidural Administration for Surgery:
0.5% concentration: 75 to 150 mg (15 to 30 mL); onset of action in 15 to 30 minutes with a duration of 2 to 4 hours
0.75% concentration: 113 to 188 mg (15 to 25 mL); onset of action in 10 to 20 minutes with a duration of 3 to 5 hours
1% concentration: 150 to 200 mg (15 to 20 mL); onset of action in 10 to 20 minutes with a duration of 4 to 6 hours

Thoracic Epidural Administration for Surgery:
0.5% concentration: 25 to 75 mg (5 to 15 mL); onset of action in 10 to 20 minutes
0.75% concentration: 38 to 113 mg (5 to 15 mL); onset of action in 10 to 20 minutes

Major Nerve Block (e.g., brachial plexus block):
0.5% concentration: 175 to 250 mg (35 to 50 mL); onset of action in 15 to 30 minutes with a duration of 5 to 8 hours
0.75% concentration: 75 to 300 mg (10 to 40 mL); onset of action in 10 to 25 minutes with a duration of 6 to 10 hours

Comments:

• The dose for major nerve blocks must be adjusted based on site of administration and patient status.
• Supraclavicular brachial plexus blocks may be associated with a higher frequency of serious adverse events.

Usual Adult Dose for Cesarean Section

0.5% concentration: 100 to 150 mg (20 to 30 mL); onset of action in 15 to 25 minutes with a duration of 2 to 4 hours
0.75% concentration: 113 to 150 mg (15 to 20 mL); onset of action in 10 to 20 minutes with a duration of 3 to 5 hours

Usual Adult Dose for Labor Pain

Lumbar Epidural Administration:

• Initial dose: 20 to 40 mg (10 to 20 mL) of 0.2% solution; onset of action 10 to 15 minutes with a duration of 0.5 to 1.5 hours
• Continuous infusion: 12 to 28 mg/hr (6 to 14 mL/hr) of 0.2% solution
• Incremental injections (top-up): 20 to 30 mg/hr (10 to 15 mL/hr) of 0.2% solution

Usual Adult Dose for Pain

Lumbar Epidural Administration:

• Continuous infusion: 12 to 28 mg/hr (6 to 14 mL/hr) of 0.2% solution

• Continuous infusion: 12 to 28 mg/hr (6 to 14 mL/hr) of 0.2% solution

Renal Dose Adjustments

Use with caution; this drug and its metabolites are known to be excreted via the kidney and the risk of toxic reactions may be greater in patients with impaired renal function.

Liver Dose Adjustments

Use with caution; patients with severe hepatic disease are at a greater risk of developing toxic plasma concentrations due to the inability to metabolize local anesthetics normally.

Dose Adjustments

• Doses should be reduced in debilitated, elderly patients and acutely ill patients those with cardiac and/or liver disease.

• For the treatment of postoperative pain, the following technique can be recommended if regional anesthesia was not used intraoperatively: an initial epidural block with 5 to 7 mL induced via an epidural catheter; analgesia is maintained with an infusion of 2 mg/mL of 0.2% solution

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Rapid injection of a large volume should be avoided and incremental doses always used.
• An adequate test dose (3 to 5 mL) of short acting local anesthetic containing epinephrine prior to induction of complete block should occur and be repeated if the patient is moved as to have displaced the epidural catheter.
• Allow for adequate time for onset of anesthesia following administration of each test dose.
• The lowest effective dose and concentration required for desired result should be used.
• Disinfecting agents containing heavy metals, which cause release of ions (mercury, zinc, copper, etc.) should not be used for skin or mucous membrane disinfection as they have been related to incidents of swelling and edema.
• Clinical experience supports use of epidural infusions for up to 72 hours.
• Not approved for intraarticular infusions following arthroscopic and other surgical procedures.
• The doses provided are considered necessary to produce a successful block and should be regarded as guidelines for use in adults.
• Standard textbooks should be consulted for specific techniques and procedures.
• The manufacturer product information should be consulted.

• For single use only and preservative free; any unused solution remaining in an opened container should be discarded immediately.
• Continuous infusion bottles should not be left in place for more than 24 hours.

• If chemical disinfection of container surface is desired, isopropyl alcohol (91%) or ethyl alcohol (70%) should be used.
• When a container is required to have a sterile outside, a Sterile-Pak should be used.
• Glass containers may be used as an alternative and be autoclaved once; stability has been demonstrated using a targeted F(0) of 7 minutes at 121C.
• The manufacturer product information should be consulted.

• The solubility of this drug is limited at pH above 6 and therefore, care must be taken as precipitation may occur if mixed with alkaline solutions.
• 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.

• Careful and constant monitoring of cardiovascular and respiratory vital signs (e.g., adequacy of ventilation) and patient's state of consciousness should be performed after each injection.