Active Ingredient: Bupivacaine
For this indication, competent medicine agencies globally authorize below treatments:
Peridural
6 - 37.5 mg
From 6 To 37.5 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.
| Acute pain management | Conc mg/ml | Volume ml | Dose mg | Onset min | Duration of effect hours7 |
|---|---|---|---|---|---|
| Lumbar Epidural Administration | |||||
| Intermittent injections3 (e.g. post-operative pain relief) | 2.5 | 6-15; minimum interval 30 minutes | 15-37.5; minimum interval 30 minutes | 2-5 | 1-2 |
| Lumbar Epidural Administration | |||||
| Continuous infusion4 | 1.25 | 10-15/h | 12.5-18.8/h | - | - |
| 2.5 | 5-7.5/h | 12.5-18.8/h | - | - | |
| Lumbar Epidural Administration | |||||
| Continuous infusion, labour pain relief4 | 1.25 | 5-10/h | 6.25-12.5/h | - | - |
| Thoracic Epidural Administration | |||||
| Continuous infusion4 | 1.25 | 5-10/h | 6.3-12.5/h | - | - |
| 2.5 | 4-7.5/h | 10-18.8/h | - | - | |
3 In total ≤400 mg/24 h.
4 This solution is often used for epidural administration in combination with a suitable opioid for pain management. In total ≤400 mg/24 h.
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.
Intra-articular
5 - 100 mg
From 5 To 100 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.
| Acute pain management | Conc mg/ml | Volume ml | Dose mg | Onset min | Duration of effect hours7 |
|---|---|---|---|---|---|
| Intra-Articular Block6 | |||||
| (e.g. single injection following knee arthroscopy) | 2.5 | ≤40 | ≤1005 | 5-10 | 2-4 h after wash out |
6 There have been post-marketing reports of chondrolysis in patients receiving post-operative intra-articular continuous infusion of local anaesthetics. Marcain is not approved for this indication
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.
Infiltration
5 - 150 mg
From 5 To 150 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.
| Acute pain management | Conc mg/ml | Volume ml | Dose mg | Onset min | Duration of effect hours7 |
|---|---|---|---|---|---|
| Field Block | |||||
| (e.g. minor nerve blocks and infiltration) | 2.5 | ≤60 | ≤150 | 1-3 | 3-4 |
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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