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bupivacaine/ epinephrine
generic
Black Box Warnings .
Obstetrical Use
contraindicated for obstetrical paracervical block; 0.75% conc. (except hyperbaric form) not recommended for obstetrical anesthesia; cardiac arrest w/ difficult resuscitation or death during epidural anesthesia in obstetric pts has occurred; systemic toxicity from accidental intravascular inj. can cause seizures and cardiac arrest; reserve 0.75% conc. for surgical procedures requiring high degree of muscle relaxation and prolonged effect
Adult Dosing .
Dosage forms: INJ (0.25%/1:200,000): 2.5 mg per mL; INJ (0.5%/1:200,000): 5 mg per mL
Dosage Form Details
- [formulation clarification]
- Info: some concentrations methylparaben-free (MPF)
Special Note
- [equivalency or interchangeability info]
- Info: not interchangeable w/ bupivacaine liposomal; do not substitute on a mg to mg basis
- [strength clarification]
- Info: dose based on bupivacaine component
local anesthesia
- [infiltration, dental]
- Dose: 9 mg (0.5%/1:200,000) via infiltration x1 for single site; Max: 90 mg/procedure; Info: may repeat dose x1 after 2-10min; onset 2-10min, peak 30-45min, duration 3-6h
- [infiltration, all other procedures]
- Dose: up to 225 mg (0.25%/1:200,000) via infiltration x1; Max: 400 mg/24h; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
regional anesthesia
- [peripheral nerve block, dental]
- Dose: 9 mg (0.5%/1:200,000) perineurally x1 for single site; Max: 90 mg/procedure; Info: may repeat dose x1 after 2-10min; onset 2-10min, peak 30-45min, duration 3-6h
- [peripheral nerve block, all other procedures]
- Dose: 25-225 mg (0.5%/1:200,000) perineurally x1; Max: 400 mg/24h; Alt: 12.5-225 mg (0.25%/1:200,000) perineurally x1; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
- [caudal block]
- Dose: 75-150 mg (0.5%/1:200,000 MPF) intracaudally x1; Max: 400 mg/24h; Alt: 37.5-75 mg (0.25%/1:200,000 MPF) intracaudally x1; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
- [lumbar block]
- Dose: 50-100 mg (0.5%/1:200,000 MPF) epidurally x1; Max: 400 mg/24h; Alt: 25-50 mg (0.25%/1:200,000 MPF) epidurally x1; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
epidural test dose
- [10-15 mg (0.5%/1:200,000 MPF) epidurally x1]
- Info: give before initial full dose and any repeat full doses
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [see below]
- mild impairment: not defined, caution advised; moderate-severe impairment: consider decr. usual dose
Peds Dosing .
- Dosage forms: INJ (0.25%/1:200,000): 2.5 mg per mL; INJ (0.5%/1:200,000): 5 mg per mL
Dosage Form Details
- [formulation clarification]
- Info: some concentrations methylparaben-free (MPF)
Special Note
- [equivalency or interchangeability info]
- Info: not interchangeable w/ bupivacaine liposomal; do not substitute on a mg to mg basis
- [strength clarification]
- Info: dose based on bupivacaine component
local anesthesia
- [infiltration, 12 yo and older]
- Dose: up to 225 mg (0.25%/1:200,000) via infiltration x1; Max: 3 mg/kg/dose; 400 mg/24h; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
regional anesthesia
- [peripheral nerve block, 12 yo and older]
- Dose: 25-225 mg (0.5%/1:200,000) perineurally x1; Max: 3 mg/kg/dose; 400 mg/24h; Alt: 12.5-225 mg (0.25%/1:200,000) perineurally x1; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
- [caudal block, 12 yo and older]
- Dose: 75-150 mg (0.5%/1:200,000 MPF) intracaudally x1; Max: 3 mg/kg/dose; 400 mg/24h; Alt: 37.5-75 mg (0.25%/1:200,000 MPF) intracaudally x1; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
- [lumbar block, 12 yo and older]
- Dose: 50-100 mg (0.5%/1:200,000 MPF) epidurally x1; Max: 3 mg/kg/dose; 400 mg/24h; Alt: 25-50 mg (0.25%/1:200,000 MPF) epidurally x1; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
epidural test dose
- [12 yo and older]
- Dose: 10-15 mg (0.5%/1:200,000 MPF) epidurally x1; Info: give before initial full dose and any repeat full doses
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [see below]
- mild impairment: not defined, caution advised; moderate-severe impairment: consider decr. usual dose