IN RECOMMENDED DOSES LEVO-BUPIVACAINE PRODUCES COMPLETE SENSORY BLOCKADE BUT THE CONCENTRATION OF LEVO-BUPIVACAINE SOLUTION USED AFFECTS THE EXTENT OF MOTOR BLOCKADE ACHIEVED. A 0.25% SOLUTION GENERALLY PRODUCES INCOMPLETE MOTOR BLOCK, A 0.5% SOLUTION WILL USUALLY PRODUCE MOTOR BLOCK AND SOME MUSCLE RELAXATION, AND COMPLETE MOTOR BLOCK AND MUSCLE RELAXATION CAN BE ACHIEVED WITH A 0.75% SOLUTION.
THE DOSAGE OF LEVO-BUPIVACAINE USED DEPENDS ON THE SITE OF INJECTION AND THE PROCEDURE USED, AS WELL AS THE STATUS OF THE PATIENT.IN THE UK THE SUGGESTED GENERAL MAXIMUM SINGLE DOSE OF LEVO- BUPIVACAINE HYDROCHLORIDE IS 150 MG WITH OR WITHOUT ADRENALINE FOLLOWED IF NECESSARY BY DOSES OF UP TO 50 MG EVERY 2 HOURS. IN THE USA THE RECOMMENDED MAXIMUM SINGLE DOSE IS 175 MG OF THE PLAIN PREPARATION OR 225 MG WHEN GIVEN WITH ADRENALINE; DOSES MAY BE REPEATED AT INTERVALS OF NOT LESS THAN 3 HOURS BUT THE TOTAL DAILY DOSE SHOULD NOT EXCEED 400 MG. THE DOSE SHOULD BE REDUCED IN THE ELDERLY, IN CHILDREN, IN DEBILITATED PATIENTS, AND IN CARDIAC OR HEPATIC DISEASE.
A TEST DOSE OF LEVO-BUPIVACAINE, PREFERABLY WITH ADRENALINE, SHOULD BE GIVEN BEFORE STARTING EPIDURAL BLOCK TO DETECT INADVERTENT INTRAVASCULAR INJECTION. SUBSEQUENT DOSES SHOULD BE GIVEN IN SMALL INCREMENTS.
SOLUTIONS WITH OR WITHOUT ADRENALINE MAY BE USED FOR MOST LOCAL ANAESTHETIC TECHNIQUES AND PROCEDURES APART FROM DENTAL INFILTRATION, WHEN ADRENALINE IS ADDED TO THE SOLUTION (SEE BELOW).
FOR INFILTRATION ANAESTHESIA LEVO-BUPIVACAINE HYDROCHLORIDE IS TYPICALLY USED AS A 0.25% SOLUTION IN DOSES UP TO THE RECOMMENDED MAXIMUM (SEE ABOVE). WHEN A LONGER DURATION OF ANAESTHESIA IS REQUIRED, AS IN DENTAL OR SURGICAL PROCEDURES OF THE MAXILLARY AND MANDIBULAR AREA, A 0.5% SOLUTION WITH ADRENALINE 1 IN 200 000 HAS BEEN USED BUT A TOTAL DOSE OF 90 MG (18 ML) SHOULD NOT BE EXCEEDED OVER A SINGLE DENTAL SITTING.
FOR PERIPHERAL NERVE BLOCK THE USUAL DOSE IS 12.5 MG (5 ML) AS A 0.25% SOLUTION OR 25 MG (5 ML) AS A 0.5% SOLUTION, ALTHOUGH DOSES UP TO THE RECOMMENDED MAXIMUM SINGLE DOSE (SEE ABOVE) MAY ALSO BE GIVEN. A 0.75% SOLUTION HAS BEEN USED FOR RETROBULBAR BLOCK IN OPHTHALMIC SURGERY IN A DOSE OF 15 TO 30 MG (2 TO 4 ML).
FOR SYMPATHETIC NERVE BLOCK 50 TO 125 MG (20 TO 50 ML) AS A 0.25% SOLUTION IS RECOMMENDED.
FOR LUMBAR EPIDURAL BLOCK IN SURGERY A 0.25% SOLUTION OF LEVO-BUPIVACAINE HYDROCHLORIDE MAY BE USED IN A DOSE OF 25 TO 50 MG (10 TO 20 ML) OR AS A 0.5% SOLUTION IN A DOSE OF 50 TO 100 MG (10 TO 20 ML). A 0.75% SOLUTION IS ALSO USED FOR INDUCTION OF LUMBAR EPIDURAL BLOCK IN NON-OBSTETRIC SURGERY IN A SINGLE DOSE OF 75 TO 150 MG (10 TO 20 ML). FOR CAUDAL BLOCK IN SURGERY 37.5 TO 75 MG (15 TO 30 ML) AS A 0.25% SOLUTION OR 75 TO 150 MG (15 TO 30 ML) AS A 0.5% SOLUTION MAY BE USED. IN THE MANAGEMENT OF ACUTE PAIN LEVO-BUPIVACAINE MAY BE GIVEN AS AN EPIDURAL BOLUS OR BY CONTINUOUS INFUSION. FOR ANALGESIA DURING LABOUR, DOSES OF 15 TO 30 MG (6 TO 12 ML) AS A 0.25% SOLUTION OR 30 TO 60 MG (6 TO 12 ML) AS A 0.5% SOLUTION HAVE BEEN RECOMMENDED AS A BOLUS FOR LUMBAR BLOCK. ALTERNATIVELY, WHEN GIVEN AS AN INFUSION, A DOSE OF 10 TO 15 MG (10 TO 15 ML) PER HOUR AS A 0.1% SOLUTION OR 10 TO 15 MG (8 TO 12 ML) PER HOUR AS A 0.125% SOLUTION HAS BEEN RECOMMENDED FOR LUMBAR BLOCK. LEVO-BUPIVACAINE MAY ALSO BE GIVEN AS A BOLUS CAUDAL INJECTION FOR LABOUR PAIN; DOSES OF 25 TO 50 MG (10 TO 20 ML) AS A 0.25% SOLUTION OR 50 TO 100 MG (10 TO 20 ML) AS A 0.5% SOLUTION ARE RECOMMENDED. FOR POSTOPERATIVE PAIN BUPIVACAINE MAY BE GIVEN AS AN EPIDURAL INFUSION IN DOSES OF 4 TO 15 MG (4 TO 15 ML) PER HOUR AS A 0.1% SOLUTION OR 5 TO 15 MG (4 TO 12 ML) PER HOUR AS A 0.125% SOLUTION.
HYPERBARIC SOLUTIONS OF LEVO-BUPIVACAINE HYDROCHLORIDE WITHOUT ADRENALINE MAY BE USED FOR SPINAL BLOCK. PREPARATIONS CONTAINING 0.5% ARE AVAILABLE AND ARE GIVEN IN DOSES OF 10 TO 20 MG (2 TO 4 ML).