Marcaine 0.5% Adrenaline Dosage/Direction for Use

Marcain with Adrenaline 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.
In order to prevent inadvertent intravascular injections, it is important that great caution be exercised. Careful 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 controls of heart rate. In epidural injection of high doses, a test dose of 3-5 ml Marcain adrenaline is recommended. An inadvertent intravascular injection can cause e.g. a brief increase in heart rate and inadvertent intrathecal injection can produce signs of spinal block. If toxic symptoms occur, the injection must be discontinued immediately.
Bupivacaine should only be used by or under the supervision of doctors experienced in local or regional anaesthesia techniques.
Bupivacaine hydrochloride is available in adrenaline or non-adrenaline forms and in different presentations.
The form, concentration and presentation used vary as a function of the indication and the ultimate objective (surgical anaesthesia or pure analgesia) and the age and pathological state of the patient.
The use of adrenaline forms prolongs the period of action. The more concentrated forms produce a more constant and more intense motor block.
The following are average posologies given for information: Surgical anaesthesia: Peridural: Adults: 0.50 percent (5 mg/ml) bupivacaine hydrochloride: 6 to 8 mg per segment, not exceeding 12 to 24 ml in total.
Caudal: Children: 0.25 percent (2.5 mg/ml) bupivacaine hydrochloride: 0.6-0.8 ml/kg = 1.5-2.mg/kg.
Adults: 0.50 percent (5 mg/ml) bupivacaine hydrochloride: 15 to 30 ml.
Plexic blocks: 0.50 percent (5 mg/ml) bupivacaine hydrochloride preferably with adrenaline: 20 to 30 ml.
0.25 percent (2.5 mg/ml) bupivacaine hydrochloride preferably with adrenaline: 25 to 40 ml.
Truncular blocks: 0.25 percent (2.5 mg/ml) bupivacaine hydrochloride or 0.5 percent (5 mg/ml) bupivacaine hydrochloride: a few ml to 15 or 20 ml depending on the nerve.
Intercostal block: 0.25 percent (2.5 mg/ml) bupivacaine hydrochloride: 1 to 2 ml per nerve (never exceed the 100 mg dose, i.e. 40 ml).
Obstetric anaesthesia: The doses are initial doses, which if required may be repeated every two to three hours.
Epidural anaesthesia (for vaginal delivery and vacuum extraction): 6-8-10 ml (15-50 mg bupivacaine hydrochloride).
Caudal anaesthesia (for vaginal delivery and vacuum extraction): 6-8-10 ml (15-50 mg bupivacaine hydrochloride).
Pudendal block (on each side): 5-10 ml (12.5-50 mg bupivacaine hydrochloride).
Treatment of pain: 0.25 percent (2.5 mg/ml) bupivacaine hydrochloride.
Peridural analgesia: 5 to 15 ml to be renewed approximately every 6 hours.
Various blocks: 8 to 20 ml.
Maximum recommended doses: Marcain with Adrenaline 2.5 mg/ml + 5 micrograms/ml: 60 ml (150 mg bupivacaine hydrochloride).
Marcain with Adrenaline 5 mg/ml + 5 micrograms/ml: 30 ml (150 mg bupivacaine hydrochloride).
The maximum recommended dose on one and the same occasion is calculated on the basis of 2 mg/kg bodyweight, and for adults is a maximum of 150 mg within a four-hour period. The maximum permissible dose during a 24-hour period is 400 mg (80 ml Marcain with Adrenaline 5 mg/ml + 5 micrograms/ml). The total dose must be corrected on the basis of the patient's age, constitution and other relevant circumstances.
Do not reuse a bottle once opened.