l INDICATIONS AND DOSE

Acute postoperative pain

 BY CONTINUOUS EPIDURAL INFUSION

 Adult: 12.5–18.75 mg/hour, dose administered using a 1.25 mg/mL (0.125%) or 2.5 mg/mL (0.25%) solution; maximum 400 mg per day Acute labour pain

 BY LUMBAR EPIDURAL

 Adult: 15–25 mg, repeated at intervals of at least 15 minutes, dose administered using a 2.5 mg/mL (0.25%) solution; maximum 400 mg per day

 BY CONTINUOUS EPIDURAL INFUSION

 Adult: 5–12.5 mg/hour, dose administered using a 1.25 mg/mL (0.125%) solution; maximum 400 mg per day Surgical anaesthesia, peripheral nerve block 

BY REGIONAL ADMINISTRATION

 Adult: 2.5–150 mg, dose administered using a 2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution Surgical anaesthesia, peribulbular nerve block

 BY REGIONAL ADMINISTRATION

 Adult: 37.5–112.5 mg, dose administered using a 7.5 mg/mL (0.75%) solution Surgical anaesthesia for caesarean section 

BY LUMBAR EPIDURAL

 Adult: 75–150 mg, to be given over 15 –20 minutes, dose administered using a 5 mg/mL (0.5%) solution Surgical anaesthesia

 BY LUMBAR EPIDURAL

 Adult: 50–150 mg, to be given over 5 minutes, dose administered using a 5 mg/mL (0.5%) or 7.5 mg/mL (0.75%) solution

 BY INTRATHECAL INJECTION

 Adult: 15 mg, dose administered using a 5 mg/mL (0.5%) solution 

 BY LOCAL INFILTRATION

 Adult: 2.5–150 mg, dose administered using a 2.5 mg/mL (0.25%) solution

DOSES AT EXTREMES OF BODY-WEIGHT

 To avoid excessive dosage in obese patients, dose should be calculated on the basis of ideal body-weight.

IMPORTANT SAFETY INFORMATION

The licensed doses stated may not be appropriate in some settings and expert advice should be sought. Should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and should not be administered parenterally unless adequate resuscitation equipment is available.

l CONTRA-INDICATIONS

Avoid injection into infected tissues . avoid injection into inflamed tissues . intravenous regional anaesthesia (Bier’s block). preparations containing preservatives should not be used for caudal, epidural, or spinal block

CONTRA-INDICATIONS, FURTHER INFORMATION

 Injection site Manufacturer advises local anaesthetics should not be injected into inflamed or infected tissues. Increased absorption into the blood increases the possibility of systemic side-effects, and the local anaesthetic effect may also be reduced by altered local pH.

l CAUTIONS

Cardiovascular disease . complete heart block . debilitated patients (consider dose reduction). elderly (consider dose reduction). epilepsy . hypovolaemia . impaired cardiac conduction . impaired respiratory function . myasthenia gravis . shock

l INTERACTIONS → Appendix 1:

anaesthetics, local

l SIDE-EFFECTS

 Common or very common Anaemia . back pain . dizziness . fever. headache . hypotension . nausea . procedural pain . vomiting  Frequency not known Angioedema . apnoea . arrhythmias . asthenia . atrioventricular block . bladder disorder. cardiac arrest. drowsiness . eye disorders . faecal incontinence . flushing . loss of consciousness . muscle twitching . muscle weakness . nerve disorders . neurological injury . oral hypoaesthesia . paralysis . priapism .respiratory disorders . seizure . sensation abnormal . skin reactions . sneezing . sweat changes . syncope . vision blurred

SIDE-EFFECTS, FURTHER INFORMATION

The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. Systemic toxicity can occur due to inadvertent intravascular injection. The onset of toxicity can be unpredictable and delayed. Monitor as per local protocol for at least 30 minutes after administration.

l ALLERGY AND CROSS-SENSITIVITY

 Hypersensitivity and cross-sensitivity Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as tetracaine; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be avoided by using the alternative chemical type.

l PREGNANCY

Large doses during delivery can cause neonatal respiratory depression, hypotonia, and bradycardia after epidural block. Avoid if possible in the first trimester—toxicity in animal studies. May cause fetal distress syndrome. Do not use for paracervical block in obstetrics. Do not use 7.5 mg/mL strength in obstetrics.

l BREAST FEEDING

Amount too small to be harmful.

 l HEPATIC IMPAIRMENT

Manufacturer advises caution in impairment or patients with reduced hepatic blood flow (no information available).

l DIRECTIONS FOR ADMINISTRATION

For 1.25 mg/mL concentration dilute standard solutions with sodium chloride 0.9%.

l PRESCRIBING AND DISPENSING INFORMATION

Levobupivacaine is an isomer of bupivacaine.