l INDICATIONS AND DOSE

Acute pain, peripheral nerve block

 BY REGIONAL ADMINISTRATION

 Adult: 10–20 mg/hour, dose administered as a continuous infusion or by intermittent injection using a 2 mg/mL (0.2%) solution Acute pain, field block 

 BY REGIONAL ADMINISTRATION

 Adult: 2–200 mg, dose administered using a 2 mg/mL (0.2%) solution Acute pain, lumbar epidural block

 BY LUMBAR EPIDURAL

 Adult: 20–40 mg, followed by 20–30 mg at least every 30 minutes, dose administered using a 2 mg/mL (0.2%) solution 

 CONTINUOUS EPIDURAL INFUSION

 Adult: Up to 28 mg/hour, dose administered using a 2 mg/mL (0.2%) solution Postoperative pain, thoracic epidural block

 BY CONTINUOUS EPIDURAL INFUSION

 Adult: 12–28 mg/hour, dose administered using a 2 mg/mL (0.2%) solution Surgical anaesthesia, field block

 BY REGIONAL ADMINISTRATION

 Adult: 7.5–225 mg, dose administered using a 7.5 mg/mL (0.75%) solution Surgical anaesthesia, major nerve block (brachial plexus block)

 BY REGIONAL ADMINISTRATION

 Adult: 225–300 mg, dose administered using a 7.5 mg/mL (0.75%) solution Surgical anaesthesia, thoracic epidural block (to establish block for postoperative pain)

 BY THORACIC EPIDURAL

 Adult: 38–113 mg, dose administered using a 7.5 mg/mL (0.75%) solution Surgical anaesthesia for caesarean section

 BY LUMBAR EPIDURAL

Adult: 113–150 mg, to be administered in incremental doses using a 7.5 mg/mL (0.75%) solution Surgical anaesthesia, lumbar epidural block

BY LUMBAR EPIDURAL

 Adult: 113–200 mg, dose administered using a 7.5 mg/mL (0.75%) or 10 mg/mL (1%) solution

DOSES AT EXTREMES OF BODY-WEIGHT

 To avoid excessive dosage in obese patients, dose may need to be calculated on the basis of ideal bodyweight. IMPORTANT SAFETY INFORMATION 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

Acute porphyrias p. 1095 . 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 Arrhythmias . back pain . chills . dizziness . headache . hypertension . hypotension . nausea . sensation abnormal . urinary retention . vomiting Uncommon Anxiety . dyspnoea . hypothermia . neurotoxicity . syncope  Rare or very rare Cardiac arrest  Frequency not known Dyskinesia

SIDE-EFFECTS, FURTHER INFORMATION

Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection. The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. 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

Not known to be harmful. Do not use for paracervical block in obstetrics.

l BREAST FEEDING

Not known to be harmful.

l HEPATIC IMPAIRMENT

Manufacturer advises caution in severe impairment. Dose adjustments Manufacturer advises consider dose reduction for repeat doses in severe impairment.

l RENAL IMPAIRMENT

Caution in severe impairment. Increased risk of systemic toxicity in chronic renal failure