What is the dose of 0.25% bupivacaine (Marcaine)?

From the Guidelines

The maximum safe dose of 0.25% marcaine (bupivacaine) is 2.5 mg/kg of body weight, which translates to 1 mL/kg for a 0.25% solution, as recommended by the most recent and highest quality study 1.

Key Considerations

• Bupivacaine is a long-acting amide local anesthetic with an onset of action within 5-10 minutes and duration of 2-8 hours depending on the site of injection.
• It works by blocking sodium channels in nerve membranes, preventing the initiation and transmission of nerve impulses.
• Care must be taken not to exceed the maximum dose as bupivacaine toxicity can cause serious cardiovascular effects including arrhythmias and cardiac arrest, as well as central nervous system effects like seizures.

Important Details

• The recommended maximum dose is based on the study by the European Society for Paediatric Anaesthesiology (ESPA) Pain Management Ladder Initiative, which provides guidance on postoperative pain management in children 1.
• The use of epinephrine with bupivacaine can cause vasoconstriction, which slows systemic absorption, reduces bleeding, and prolongs the anesthetic effect.
• It is essential to follow the recommended dosage and administration guidelines to minimize the risk of toxicity and ensure safe and effective pain management.

Administration Guidelines

• The maximum dose of 0.25% bupivacaine is 1 mL/kg, which corresponds to 2.5 mg/kg of body weight.
• The dose should be calculated based on the patient's weight, and the solution should be administered carefully to avoid exceeding the maximum recommended dose.
• Monitoring of the patient's vital signs and neurological function is crucial during and after administration of bupivacaine to promptly detect any potential adverse effects.

From the FDA Drug Label

In obstetrics, only the 0.5% and 0.25% concentrations should be used; incremental doses of 3 mL to 5 mL of the 0. 5% solution not exceeding 50 mg to 100 mg at any dosing interval are recommended. There is no specific dose recommendation for 0.25% Marcaine in the provided drug labels. However, it is mentioned that in obstetrics, 0.25% concentration can be used, but the dose recommendation is only provided for the 0.5% solution.

• The dose for 0.5% solution is 3 mL to 5 mL, not exceeding 50 mg to 100 mg at any dosing interval.
• Since the 0.25% concentration is half of the 0.5% concentration, it can be inferred that the dose for 0.25% would be similar in volume, but the exact dose in milligrams is not provided.
• It is recommended to consult the FDA label or other reliable sources for more information on the specific dosing of 0.25% Marcaine 2.

From the Research

Marcaine Dose Information

• The provided studies do not specifically mention a 0.25% marcaine dose.
• However, studies 3 and 4 discuss the use of liposomal bupivacaine, which is a type of local anesthetic, for postoperative pain management.
• Study 5 examines the effect of bupivacaine, a local anesthetic, on nerve tissue oximetry and nerve blood flow.

Local Anesthetic Information

• Local anesthetics, such as bupivacaine, have been shown to decrease nerve blood flow and tissue oximetry values 5.
• The addition of adjuvants, such as epinephrine or clonidine, to bupivacaine does not significantly impact nerve tissue oximetry compared to bupivacaine alone 5.
• Study 6 discusses the importance of local anesthetics in multimodal analgesia and the risk of local anesthetic systemic toxicity (LAST).

Relevance to Marcaine Dose

• While the studies provide information on local anesthetics and their effects, they do not specifically address the 0.25% marcaine dose.
• Further research would be necessary to determine the efficacy and safety of a 0.25% marcaine dose, as the provided studies do not provide sufficient information on this topic 3, 4.