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Marcaine
bupivacaine
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%): 2.5 mg per mL; INJ (0.5%): 5 mg per mL; INJ (0.75%): 7.5 mg per mL
Special Note
- [formulation clarification]
- Info: not interchangeable w/ bupivacaine liposomal; do not substitute on a mg to mg basis; some concentrations methylparaben-free (MPF)
local anesthesia
- [infiltration]
- Dose: up to 175 mg (0.25%) 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]
- Dose: 25-175 mg (0.5%) perineurally x1; Max: 400 mg/24h; Alt: 12.5-175 mg (0.25%) perineurally x1; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
- [retrobulbar block]
- Dose:15-30 mg (0.75%) retrobulbar injection x1; Max: 400 mg/24h; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
- [sympathetic nerve block]
- Dose: 50-125 mg (0.25%) perineurally x1; Max: 400 mg/24h; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
- [caudal block]
- Dose: 75-150 mg (0.5% MPF) intracaudally x1; Max: 400 mg/24h; Alt: 37.5-75 mg (0.25% 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% MPF) epidurally x1; Max: 400 mg/24h; Alt: 25-50 mg (0.25% MPF) epidurally x1; 75-150 mg (0.75% MPF) epidurally x1; Info: may repeat dose q3h prn (0.25% MPF or 0.5% MPF only); do not use 0.75% conc. for obstetrics; onset 2-10min, peak 30-45min, duration 3-6h
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%): 2.5 mg per mL; INJ (0.5%): 5 mg per mL; INJ (0.75%): 7.5 mg per mL
Special Note
- [formulation clarification]
- Info: not interchangeable w/ bupivacaine liposomal; do not substitute on a mg to mg basis; some concentrations methylparaben-free (MPF)
local anesthesia
- [infiltration, 12 yo and older]
- Dose: up to 175 mg (0.25%) via infiltration x1; Max: 2.5 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: 25-175 mg (0.5%) perineurally x1; Max: 2.5 mg/kg/dose; 400 mg/24h; Alt: 12.5-175 mg (0.25%) perineurally x1; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
- [retrobulbar block, 12 yo and older]
- Dose:15-30 mg (0.75%) retrobulbar injection x1; Max: 2.5 mg/kg/dose; 400 mg/24h; Info: may repeat dose q3h prn; onset 2-10min, peak 30-45min, duration 3-6h
- [sympathetic nerve block, 12 yo and older]
- Dose: 50-125 mg (0.25%) perineurally x1; Max: 2.5 mg/kg/dose; 400 mg/24h; 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% MPF) intracaudally x1; Max: 2.5 mg/kg/dose; 400 mg/24h; Alt: 37.5-75 mg (0.25% 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% MPF) epidurally x1; Max: 2.5 mg/kg/dose; 400 mg/24h; Alt: 25-50 mg (0.25% MPF) epidurally x1; 75-150 mg (0.75% MPF) epidurally x1; Info: may repeat dose q3h prn (0.25% MPF or 0.5% MPF only); do not use 0.75% conc. for obstetrics; onset 2-10min, peak 30-45min, duration 3-6h
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