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Local anesthetic agents dosing for epidural anesthesia

Local anesthetic agents dosing for epidural anesthesia
Local anesthetic Dose (mg) Peak cephalad block height Time to two-segment regression
(1 SD or range) (minutes)*		 Recommended time interval for top-up dose (minutes)
Chloroprocaine 2 to 3% plus
1:200,000 epinephrine[1,2]		 600 T5 80 (15) 45
Lidocaine 1.5 to 2% plus
1:200,000 epinephrine[2,3]		 300 to 400 T4 100 (50 to 60) 60
Bupivacaine 0.5 to 0.75% (plain)[4,5] 100 to 150 T5 150 to 190 (60 to 80) 120
Ropivacaine 1% (plain)[6]
Age 30 (18 to 40)Δ		 150 T8◊ 143 (45 to 298) 120
Ropivacaine 1% (plain)[6]
Age 51 (41 to 59)Δ		 150 T6 190 (100 to 340) 120
Ropivacaine 1% (plain)[6]
Age 71 (61 to 82)Δ		 150 T4◊ 203 (105 to 378) 120
Levobupivacaine 0.75% (plain)[7]
Age 32 (18 to 44)Δ		 125 T8◊ 166 (51) 120
Levobupivacaine 0.75% (plain)[7]
Age 57 (47 to 69)Δ		 125 T5 158 (59) 120
Levobupivacaine 0.75% (plain)[7]
Age 78 (72 to 85)Δ		 125 T5◊ 174 (61) 120
* Mean (1 SD or range).
¶ Dosing intervals are approximate guidelines. In awake and cooperative patients, clinical monitoring for signs and symptoms (increase in blood pressure and heart rate or objective evaluation of dermatomal level of block) of dermatomal regression will indicate the need for a top-up dose.
Δ Ages expressed as mean (range).
◊ Note for ropivacaine and levobupivacaine the significant difference in peak block height between the youngest and oldest age groups.
References:
  1. Liu SS, Ware PD, Rajendran S. Effects of concentration and volume of 2-chloroprocaine on epidural anesthesia in volunteers. Anesthesiology 1997; 86:1288.
  2. Kopacz DJ, Mulroy MF. Chloroprocaine and lidocaine decrease hospital stay and admission rate after outpatient epidural anesthesia. Reg Anesth 1990; 15:19.
  3. Terai T, Yukioka H, Fujimori M. A double-blind comparison of lidocaine and mepivacaine during epidural anesthesia. Acta Anaesthesiol 1993; 37:607.
  4. Kopacz DJ, Allen HW, Thompson GT. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth analg 2000; 90:642.
  5. Veering BT, Burm AGL, Van Kleef JW, et al. Epidural anesthesia with bupivacaine: Effects of age on neural blockage and pharmacokinetics. Anesth analg 1987; 66:589.
  6. Simon MJG, Veering BT, Stienstra R, et al. The effects of age on neural blockade and hemodynamic changes after epidural anesthesia with ropivacaine. Anesth analg 2002; 94:1325.
  7. Simon MJG, Veering BT, Stienstra R, et al. Effect of age on the clinical profile and systemic absorption and disposition of levobupivacaine after epidural administration. Br J Anaesth 2004; 93:512.
Adapted with permission from: Salinas FV. Pharmacology of drugs used for spinal and epidural anesthesia and analgesia. In: Spinal and epidural anesthesia, Wong C (Ed), McGraw-Hill Education 2007. Copyright © 2017 McGraw-Hill Education. McGraw-Hill Education makes no representations or warranties as to the accuracy of any information contained in the McGraw-Hill Education Material, including any warranties of merchantability or fitness for a particular purpose. In no event shall McGraw-Hill Education have any liability to any party for special, incidental, tort, or consequential damages arising out of or in connection with the McGraw-Hill Education Material, even if McGraw-Hill Education has been advised of the possibility of such damages.
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