Posology : מינונים

4.2 Posology and method of administration
Marcaine should only be used by physicians with experience of regional anaesthesia or under the supervision of such a physician. The lowest possible dose for adequate anaesthesia should be sought.

It is important to observe particular caution in order to prevent inadvertent intravascular injections. Thorough aspiration before and during injection of the main dose is recommended. The main dose should be injected slowly at 25-50 mg/minute or in divided doses, while keeping continuous verbal contact with the patient and monitoring the heart rate. In epidural injection, the administration of high doses, a test dose of 3-5 ml Marcaine with adrenaline is recommended. An inadvertent intravascular injection can cause symptoms such as a transient increase in heart rate and an inadvertent intrathecal injection can cause signs of spinal block. The injection should be discontinued immediately if there are any toxic symptoms.

The following doses are guidelines; the dosage should be adjusted according to the scope of the block and the patient's overall health status.

In infiltration anaesthesia, administer Marcaine 5 mg/ml, 5-30 ml (25-150 mg bupivacaine hydrochloride).

For diagnostic and therapeutic blocks: Marcaine 5 mg/ml, 0.5-20 ml (2.5-100 mg bupivacaine hydrochloride). For example, for trigeminal block 0.5-2.5 ml (2.5-12.5 mg) and for stellatum block 5-10 ml (25-50 mg) should be given.

In intercostal block, administer Marcaine 5 mg/ml, 2-3 ml (10-15 mg bupivacaine hydrochloride) per nerve, up to a total of ten nerves.

In major blocks (such as epidural, sacral and brachial plexis anaesthesia): Marcaine 5 mg/ml, 15-30 ml (75-150 mg bupivacaine hydrochloride).
In obstetric anaesthesia (such as epidural or caudal anaesthesia for vaginal childbirth and vacuum aspiration): Marcaine 5 mg/ml, 6-10 ml (30-50 mg bupivacaine hydrochloride). The doses given are initial doses, which may be repeated every two to three hours if required.

In epidural block (for caesarean section): Marcaine 5 mg/ml, 15-30 ml (75-150 mg bupivacaine hydrochloride).

In continuous epidural anaesthesia in the form of intermittent bolus doses, give an initial dose of Marcaine 5 mg/ml, 10 ml (50 mg bupivacaine hydrochloride) should be given initially, thereafter Marcaine 5 mg/ml, 3-8 ml (15-40 mg bupivacaine hydrochloride) every 4- 6 hours depending on the desired number of anaesthetised segments and the patient's age.

In continuous epidural infusion (such as postoperative analgesia):
Concentration Volume                    Dose
Lumbar epidural infusion:
Bolus1                             5 mg/ml        2.5-5 ml                 12.5-25 mg Infusion                           5 mg/ml        2.5-3.75 ml/hour         12.5-18.75 mg² Thoracic epidural infusion:
Bolus1                              5 mg/ml           2.5-5 ml             12.5-25 mg Infusion                            5 mg/ml           1.25-2.5 ml/hour     6.25-12.5 mg Epidural infusion for vaginal childbirth:
Bolus1                                  5 mg/ml            3-5 ml            15-25 mg Infusion                                5 mg/ml            1-2.5 ml/hour      5-12.5 mg 1) If an adequate bolus dose has not been given during the preceding hour.
2) The highest recommended dose per 24 hours should not be exceeded (see below).

Consideration should also be given to the dose given intraoperatively.

The bupivacaine dose can be reduced when used concomitantly with an opioid.
The patient must be monitored regularly during the entire time the infusion is ongoing with regards to blood pressure, heart rate and any symptoms of toxicity. The infusion must be discontinued immediately if any signs of toxicity are observed.

For children under 12 years the following dose is recommended:
Caudal block: Marcaine 5 mg/ml, 0.25 ml/kg body weight up to 10 ml.

Maximum recommended doses
The maximum recommended dose for administration at one and the same time is calculated using the figure of 2 mg/kg body weight. For adults this is a maximum of 150 mg within a four hour period.
Marcaine 5 mg/ml: 30 ml (150 mg bupivacaine hydrochloride).
The maximum recommended dose per 24 hours is 400 mg. The total dose must be adjusted with reference to the patient's age, general health and other relevant factors.