From the Guidelines
The maximum recommended dose of 0.25% Marcaine with epinephrine is 3.0 mg/kg, not to exceed the maximum allowable safe dosage, which should be calculated before administration, as indicated in the guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016 1.
Key Considerations
- The dose of 0.25% Marcaine with epinephrine should be calculated based on the patient's weight, with a maximum dose of 3.0 mg/kg, as shown in the table of commonly used local anesthetic agents for nerve block or infiltration: doses, duration, and calculations 1.
- The maximum allowable safe dosage should be calculated before administration to ensure that the patient does not receive an excessive dose, as stated in the guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016 1.
- The addition of epinephrine allows for a higher dosage range by causing vasoconstriction, which slows systemic absorption and prolongs the anesthetic effect, as mentioned in the guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016 1.
Administration Guidelines
- Always aspirate before injection to avoid intravascular administration, as recommended in the guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016 1.
- Inject slowly and monitor the patient for signs of toxicity, such as perioral numbness, metallic taste, auditory changes, seizures, or cardiovascular depression, as indicated in the guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016 1.
Important Notes
- The duration of action of 0.25% Marcaine with epinephrine is dependent on concentration, total dose, and site of administration, as well as the patient's age, as shown in the table of commonly used local anesthetic agents for nerve block or infiltration: doses, duration, and calculations 1.
- Lower doses should be used in very vascular areas, as recommended in the guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016 1.
From the FDA Drug Label
The duration of anesthesia with Bupivacaine Hydrochloride is such that for most indications, a single dose is sufficient Maximum dosage limit must be individualized in each case after evaluating the size and physical status of the patient, as well as the usual rate of systemic absorption from a particular injection site Most experience to date is with single doses of Bupivacaine Hydrochloride up to 225 mg with epinephrine 1:200,000 and 175 mg without epinephrine; more or less drug may be used depending on individualization of each case. 0. 25% ─ when used for caudal, epidural, or peripheral nerve block, produces incomplete motor block.
The dose of 0.25% Marcaine with epinephrine is not explicitly stated, but the maximum dosage limit for Bupivacaine Hydrochloride with epinephrine 1:200,000 is up to 225 mg. The dose should be individualized based on the patient's size, physical status, and injection site. For 0.25% concentration, the effect on motor function is incomplete motor block, and it should be used for operations in which muscle relaxation is not important. 2
From the Research
Dose of 0.25% Marcaine with Epinephrine
- The provided studies do not directly mention the dose of 0.25% Marcaine with epinephrine 3, 4, 5, 6, 7.
- However, the studies discuss the use of bupivacaine and ropivacaine with epinephrine in various concentrations for peripheral nerve blocks and epidural injections.
- For example, one study compared the effects of 0.5% bupivacaine with 1:200,000 epinephrine versus 0.5% ropivacaine versus 1% ropivacaine for low-volume ultrasound-guided interscalene brachial plexus block 4.
- Another study discussed the use of liposomal bupivacaine, which is a formulation of bupivacaine that can provide prolonged analgesia, but did not specify the concentration of 0.25% Marcaine with epinephrine 5, 6, 7.
Concentrations and Formulations
- The studies mention various concentrations of local anesthetics, including 0.5% bupivacaine, 0.75% ropivacaine, and 1% ropivacaine, but not 0.25% Marcaine with epinephrine 3, 4.
- Liposomal bupivacaine is discussed as a formulation that can provide prolonged analgesia, but the concentration of 0.25% Marcaine with epinephrine is not mentioned 5, 6, 7.
- The use of epinephrine as an additive to local anesthetics is mentioned, but the specific concentration of 0.25% Marcaine with epinephrine is not discussed 3, 4.