Spino

Indication
Intrathecal anesthesia, Spinal anesthesia, Epidural anesthesia, Subarachnoid anesthesia
Adult Dose
Adult: Inj Percutaneous infiltration anesth For prolonged action: 9 mg w/ adrenaline (1 in 200,000), may repeat 2-10 mins later if needed. Max: 90 mg per dental sitting. Surgical anaesthesia Peripheral nerve block 12.5 mg (as 0.25% soln) or 25 mg (as 0.5% soln) . Max: 150 mg/dose. Sympathetic nerve block As 0.25% soln: 50-125 mg. Retrobulbar block As 0.75% soln: 15-30 mg. Caudal block In surgery: 37.5-75 mg (as 0.25% soln) or 75-150 mg (as 0.5% soln). Lumbar epidural block In surgery: 25-50 mg (as 0.25% soln) and 50-100 mg (as 0.5% soln). Spinal block: 0.5% soln: 10-20 mg (2-4 mL).

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Child Dose
<12 years: Not recommended Caudal Block, Epidural Block, Local Block >12 years Local Anesthesia: Infiltration 0.25% infiltrated locally: 175 mg maximum Caudal Block: 15-30 mL of 0.25% or 0.5% (preservative free) Epidural Block Other Than Caudal Block: 10-20 mL of 0.25% or 0.5%; administer in 3-5 mL increments allowing sufficient time to detect toxic manifestations of inadvertent IV or IT administration (preservative free); for surgical procedures requiring high degree of muscle relaxation and prolonged effects administer10-20 mL of 0.75%; not to be used in obstetrical cases Peripheral or Sympathetic Nerve Block >12 years Peripheral Nerve Block: 5 mL of 0.25-0.5%; 400 mg/day maximum Sympathetic Nerve Block: 20-50 mL of 0.25%

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Contraindication
Hypersensitivity to local anaesthetics of amide type. IV regional anaesthesia; paracervical block in obstetrics; spinal anaesthesia <18 yr. Lactation. Solutions containing preservatives for caudal or epidural block. _ Mode of Action Bupivacaine blocks both the initiation and conduction of nerve impulses reducing the permeability of neuronal membranes to Na ions resulting in inhibition of depolarization w/ resultant blockade of conduction. Dextrose is a monosaccharide that is used as a source of calories and water for hydration. It helps to reduce loss of body protein and nitrogen. It also promotes glycogen deposition in the liver. Precaution Hepatic disease; CV disease; children <12 yr; pregnancy. Elderly and debilitated patients. Lactation: excretion in milk unknown/not recommended _ Side Effect CNS excitation may be followed by depression. Hypotension, bradycardia, arrhythmias and cardiac arrest; methaemoglobinaemia; seizures, restlessness, dizziness. Hypersensitivity. Prolonged block, Edema, Headache, Hypotension, Hypoventilation, Nausea, Nervousness, Palpitation, Respiratory arrest, Tachycardia, Tinnitus, Tremors, Vomiting. Potentially Fatal: Cardiac and sudden respiratory arrest. _ Pregnancy Category Note Pregnancy Category: C Lactation: excretion in milk unknown/not recommended _ Interaction Additive systemic toxic effect w/ other local anaesth or agents structurally related to amide-type local anaesth (e.g. lidocaine and mexiletine). Increased risk of myocardial depression w/ antiarrhythmics. Enhanced adverse effects w/ hyaluronidase. Decreased clearance resulting to increased plasma concentrations w/ cimetidine and ranitidine. Increased risk of adverse effects w/ beta-blockers and Ca channel blockers.