Recommended Dose of Local Anesthetic for Supratrochlear Supraorbital Nerve Block
For a supratrochlear supraorbital nerve block, the recommended dose is 0.15 ml/kg of 0.25% bupivacaine, 0.25% levobupivacaine, or 0.2% ropivacaine. 1
Local Anesthetic Options and Dosing
For supratrochlear supraorbital nerve block, use one of the following long-acting local anesthetics 1:
- Bupivacaine 0.25%: 0.15 ml/kg
- Levobupivacaine 0.25%: 0.15 ml/kg
- Ropivacaine 0.2%: 0.15 ml/kg
Maximum safe doses for peripheral nerve blocks should not be exceeded 1, 2:
- Bupivacaine: maximum 3.0 mg/kg with epinephrine, 1.3 mg/kg without epinephrine
- Levobupivacaine: maximum 3.0 mg/kg with epinephrine, 2.0 mg/kg without epinephrine
- Ropivacaine: maximum 3.0 mg/kg with epinephrine, 2.0 mg/kg without epinephrine
Important Considerations for Administration
- Use ideal body weight for dose calculation rather than actual body weight, especially in obese patients 1, 2
- Calculate the maximum allowable safe dosage (mg/kg) before administration to prevent local anesthetic systemic toxicity 2
- Consider that smaller volumes with higher concentrations of local anesthetic may provide more effective and longer-lasting blocks than larger volumes with lower concentrations 3
Special Population Considerations
- For pediatric patients, the European Society for Paediatric Anaesthesiology recommends the same volume (0.15 ml/kg) for landmark-based maxillary nerve block and external nasal nerve block 1
- Reduce doses of amide local anesthetics by 30% in infants younger than 6 months 1, 2
- Use lower doses in elderly patients and those with liver or cardiac impairment 2
Monitoring and Safety
- Monitor for signs of local anesthetic systemic toxicity, including circumoral numbness, facial tingling, slurred speech, metallic taste, auditory changes, and hallucinations 1
- Have lipid emulsion available for treatment of local anesthetic toxicity 1
- Avoid using local anesthetics in very vascular areas without dose reduction due to increased systemic absorption 1, 2
Duration of Action
- Expected duration of action for the recommended local anesthetics 1:
- Bupivacaine: 180-600 minutes
- Levobupivacaine: 180-600 minutes
- Ropivacaine: 180-600 minutes