Posology : מינונים

4.2     Posology and method of administration
Bupivacaine spinal heavy should only be used by clinicians with experience of regional anaesthesia or under their supervision. The lowest possible dose for adequate anaesthesia should be used.
The doses given below are guides for adults and the dosage should be adjusted to the individual patient.
The dose should be reduced in elderly patients and patients in late stages of pregnancy.
Time to onset       Duration
Indication            Dose               Dose         of effect        of effect ml                 mg        in minutes         in hours
(approx.)         (approx.)
Urological
1.5-3 ml          7.5-15 mg       5-8 min          2-3 hours surgery
Surgery on lower limbs,
2-4 ml           10-20 mg        5-8 min          2-3 hours including hip surgery
Abdominal surgery
(including          2-4 ml           10-20 mg        5-8 min          45-60 min caesarean section)

The recommended injection is in the L3-L4 intervertebral space.
There is currently no experience of doses higher than 20 mg.
A spinal injection is given only after the subarachnoid space has been clearly identified by means of lumbar puncture (clear cerebrospinal fluid runs out via the spinal needle or is seen on aspiration). In the event of unsuccessful anaesthesia, a new attempt to administer the drug should only be made by injecting at a different level and with a smaller volume. One cause of lack of effect may be poor intrathecal distribution of the drug, and this can be helped by altering the patient’s position.