| Regional anesthetic/usual drugs | Maximum recommended doses of LA |
Wound infiltration: - 0.2% Ropivacaine (2 mg/mL) or
- 0.25% Bupivacaine (2.5 mg/mL)
| - Use minimal volume required, not to exceed maximum recommended doses
|
Peripheral nerve blocks: - 0.2% Ropivacaine (2 mg/mL) or
- 0.25% Bupivacaine: (2.5 mg/mL)
| - Upper extremity blocks (eg, brachial plexus), lower extremity blocks (eg, femoral, sciatic, popliteal, or adductor canal block), interfascial plane blocks (TAP, rectus sheath, fascia iliaca ): 0.5 to 1.5 mg/kg
- Bupivacaine: 0.2 to 0.6 mL/kg
- Ropivacaine: 0.25 to 0.75 mL/kg
- With ultrasound guidance, lower volumes may be adequate for nerve blocks. Significant local anesthetic absorption may occur with extended fascial plane blocks
- Ilioinguinal /Iliohypogastric: 0.25 mg/kg bupivacaine or 0.2 mg/kg ropivacaine (0.1 to 0.2 mL/kg of either drug is usually sufficient for this block)
|
Caudal block: - 0.2% Ropivacaine (2 mg/mL)
- 0.25% Bupivacaine: (2.5 mg/mL)
| - Modify single-shot volume to achieve appropriate dermatomal level:
- To a T10 level: 0.5 mL/kg (ie, 1 mg/kg ropivacaine or 1.25 mg/kg bupivacaine)
- T10 to low-thoracic level: 1 mL/kg (ie, 2 mg/kg ropivacaine or 2.5 mg/kg bupivacaine)
- Maximum volume for single shot caudal: <20 mL
|
| Lumbar or thoracic epidural |
Intraoperative loading dose: - 0.2% Ropivacaine (2 mg/mL)
- 0.25% Bupivacaine: (2.5 mg/mL)
| - Usual initial lumbar loading dose:
- 0.5 mL/kg (ie, 2 mg/kg ropivacaine or 2.5 mg/kg bupivacaine)
- Maximum recommended volume <15 mL (fractionated)
- Usual initial thoracic loading dose:
- 0.3 mL/kg (ie, 0.6 mg/kg ropivacaine or 0.75 mg/kg bupivacaine), not to exceed 0.68 mL/kg = 1.7 mg/kg
- Maximum recommended volume <8 mL (fractionated)
|
| Postoperative epidural infusion Usual drug concentrations: - Bupivacaine: 0.0625 to 0.1% (0.625 to 1 mg/mL)
- Ropivacaine: 0.1% (1 mg/mL)
- 2-chlorprocaine: 1.5% (15 mg/mL)
| Continuous infusion: - <3 months of age: Bupivacaine, ropivacaine, or chloroprocaine 0.2 mg/kg/hour
- 3 months to ≤1 year of age: Bupivacaine, ropivacaine, or chloroprocaine: 0.3 mg/kg/hour
- >1 year of age: Bupivacaine or ropivacaine: 0.4 mg/kg/hour, chloroprocaine: 0.5 mg/kg/hour
|
PCEA (for children >30 kg and capable of understanding pump function): - Demand dose: 0.5 to 3 mL/dose (if utilized)
- Lockout interval: 30 to 60 minutes
- Continuous infusion: Usually ≤15 mL/hour for lumbar epidural, ≤7.5 mL/hour for thoracic epidural, for children >60 kg
- Maximum hourly dose (ie, continuous infusion dose + PCEA demand doses): ≤0.4 mg/kg/hour
|
| Maximum allowable doses¶ | |
| Drug: | Maximum dose (mg/kg) without/with epinephrine |
| Lidocaine | 4.5/7 |
| Bupivacaine | 2.5/3 |
| Ropivacaine | 3/3.5 |
| 2-Chloroprocaine | 11/14 |
