Posology : מינונים

4.2 Posology and method of administration
Bupivacaine Grindeks 5 mg/ml 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 used.

In order to prevent inadvertent intravascular injections, it is important to observe particular caution. Thorough aspiration before and during the injection of the total dose is recommended. The total dose must be injected slowly, 25-50 mg/min or in divided doses with continuous verbal contact being maintained with the patient and monitoring of heart rate. In epidural injection of high doses, a test dose of 3-5 ml Bupivacaine Grindeks 5 mg/ml with adrenaline is recommended. An inadvertent intravascular injection can cause symptoms such as a transient increase in heart rate and inadvertent intrathecal injection can produce signs of spinal block. If toxic symptoms occur, the injection must be discontinued immediately.

The doses given below are guides, and the dosage should be adjusted according to the extent of the block and the patient's general condition.

For infiltration anaesthesia: Bupivacaine Grindeks 5 mg/ml, 5-30 ml (25-150 mg bupivacaine hydrochloride) should be given.

For diagnostic and therapeutic blocks: Bupivacaine Grindeks 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.

For intercostal block: Bupivacaine Grindeks 5 mg/ml 2-3 ml (10-15 mg bupivacaine hydrochloride) per nerve up to a total of 10 nerves should be given.

For larger blocks (for example, epidural, sacral and brachial plexus anaesthesia): Bupivacaine Grindeks 5 mg/ml, 15-30 ml (75-150 mg bupivacaine hydrochloride).
For obstetric anaesthesia (for example, epidural anaesthesia and caudal anaesthesia for vaginal delivery and vacuum extraction): Bupivacaine Grindeks 5 mg/ml, 6-10 ml (30-50 mg bupivacaine hydrochloride). The doses are initial doses, which if necessary may be repeated every two to three hours.

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

For continuous epidural anaesthesia in the form of intermittent bolus doses, initially Bupivacaine Grindeks 5 mg/ml, 10 ml (50 mg bupivacaine hydrochloride) should be given, thereafter Bupivacaine Grindeks 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.

For continuous epidural infusion (for example, postoperative pain relief): 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 delivery:
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 was not given in the previous hour.
2) The maximum recommended dose per day should not be exceeded (see below).

Account must be taken of the dose given intra-operatively.

In cases of combination with an opioid the dose of bupivacaine may be reduced.
Throughout the time that the infusion is being given the patient must be monitored regularly with regard to blood pressure, heart rate and symptoms of toxicity. If any signs of a toxicity are observed the infusion must be stopped immediately.

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

Maximum recommended doses
The maximum recommended dose for administration on one and the same occasion is calculated on the basis of 2 mg/kg body weight. For adults this is a maximum of 150 mg within a four-hour period.
Bupivacaine Grindeks 5 mg/ml: 30 ml (150 mg bupivacaine hydrochloride).
The maximum recommended dose per 24 hours is 400 mg. The total dose must be corrected on the basis of the patient's age, general health and other relevant circumstances.