Dosis de Bupivacaína
Dosificación por Tipo de Procedimiento
- La dosis máxima segura de bupivacaína al 0.25% es de 2.5 mg/kg para evitar toxicidad sistémica en procedimientos de anestesia local y regional, según la sociedad de anestesia 1
- Bupivacaína 0.25%: dosis máxima de 1 ml/kg (equivalente a 2.5 mg/kg) para infiltración de heridas y bloqueos nerviosos periféricos, recomendada por la sociedad de anestesia 1, 2
- Bupivacaína 0.25%: 0.15 ml/kg para bloqueo del nervio maxilar y nervio nasal externo, específica para procedimientos en la región facial, según la sociedad de anestesia 1, 3
- Bupivacaína 0.25%: 0.2-0.3 ml/kg (máximo 10 ml) inicialmente para bloqueo epidural torácico, recomendada por la sociedad de anestesia 1, 3
- Bupivacaína 0.25%: 0.5 ml/kg (máximo 15 ml) inicialmente para bloqueo epidural lumbar, proporciona un bloqueo sensorial adecuado para procedimientos abdominales inferiores y de extremidades inferiores, según la sociedad de anestesia 1, 3
- Bupivacaína 0.25%: 1.0 ml/kg para bloqueo caudal, técnica ampliamente utilizada en población pediátrica para analgesia postoperatoria, recomendada por la sociedad de anestesia 1, 3
- Bupivacaína 0.25%: 0.2-0.5 ml/kg para bloqueo paravertebral guiado por ultrasonido, proporciona analgesia unilateral para procedimientos torácicos o abdominales, según la sociedad de anestesia 1, 3
- Bupivacaína 0.25%: 0.2-0.5 ml/kg para bloqueo del nervio femoral y bloqueo de la fascia ilíaca, efectivo para analgesia de extremidades inferiores, recomendada por la sociedad de anestesia 1, 3
- Bupivacaína 0.25%: 0.2-0.5 ml/kg por lado para bloqueo de la vaina del recto y TAP subcostal, según la sociedad de anestesia 3, 4
- Ropivacaína 0.2% puede utilizarse como alternativa con una dosis máxima de 3 mg/kg (1.5 ml/kg), recomendada por la sociedad de anestesia 1, 2
Anestesia Regional Continua
Dosis de Bupivacaína Pesada en Anestesia Espinal
Consideraciones especiales
- La dosis máxima segura de bupivacaína al 0.25% es de 2.5 mg/kg (1 ml/kg) para evitar toxicidad 5
Algoritmo de dosificación recomendado
- En pacientes ancianos o con comorbilidades significativas, se debe reducir la dosis de bupivacaína, según las características del paciente 5
Safe Bupivacaine Dosing for Pediatric Patients
Maximum Safe Dosing
- The European Society for Paediatric Anaesthesiology (ESPA) 2024 guidelines establish 2.5 mg/kg as the maximum safe dose of bupivacaine 0.25% for wound infiltration and peripheral nerve blocks in pediatric patients 6
- For a 10kg patient, the maximum safe dose translates to a maximum volume of 10 mL or 25 mg total dose 6
Alternative Considerations
- If larger volumes are needed for adequate infiltration, consider using ropivacaine 0.2% instead, which allows up to 3 mg/kg (1.5 mL/kg or 15 mL in a 10kg patient) 6
- Levobupivacaine 0.25% offers similar efficacy with potentially improved safety profile and can be used at the same 2.5 mg/kg maximum dose 6
Exparel Dosing for Fascia Iliaca Block: Alternative Approaches
Recommended Dosing Guidelines
- For a single fascia iliaca block, the American Society of Anesthesiologists recommends using 0.2-0.5 ml/kg of bupivacaine 0.25% (maximum 2.5 mg/kg total dose) for effective analgesia in patients with hip fractures and lower extremity procedures 7
- The American Society of Regional Anesthesia and Pain Medicine suggests that for ultrasound-guided fascia iliaca blocks, bupivacaine 0.25% at 0.2-0.5 ml/kg provides effective analgesia for hip fractures and lower extremity procedures 7
- Clinical studies in hip fracture patients have successfully used 30-40 mL bolus of 0.25% bupivacaine with 1:200,000 epinephrine for single-shot fascia iliaca blocks in adults, as recommended by the American College of Emergency Physicians 8, 9
Adjuvants to Prolong Duration
- The American Society of Anesthesiologists recommends adding preservative-free clonidine 1-2 mcg/kg to extend the duration of the block without using Exparel, providing reliable and predictable analgesia lasting 4-8 hours or longer 7
Safety Considerations
- The American Heart Association advises always calculating weight-based dosing to stay below the maximum safe dose of 2.5 mg/kg for bupivacaine 0.25% 7
- The American Society of Regional Anesthesia and Pain Medicine suggests considering adding low-dose epinephrine (1:200,000) to decrease systemic absorption and prolong block duration, as seen in clinical studies 8
Alternative Local Anesthetics
- The European Society of Regional Anaesthesia recommends ropivacaine 0.2% at 0.2-0.5 ml/kg (maximum 3 mg/kg) as an alternative with a potentially improved safety profile 7
- The American Society of Anesthesiologists suggests levobupivacaine 0.25% at 0.2-0.5 ml/kg offers similar efficacy with potentially reduced cardiac toxicity compared to racemic bupivacaine 7
Maximum Bupivacaine Dose Calculation
Standard Dosing Algorithm
- The maximum safe dose of bupivacaine is 2.5 mg/kg for plain solutions and up to 3 mg/kg (or 225 mg total) when combined with epinephrine 1:200,000, with doses calculated based on actual body weight in normal-weight patients and ideal body weight in obese patients, as recommended by the American Society of Anesthesiologists 10
- For pediatric patients, the maximum safe dose of bupivacaine should be calculated using actual weight with strict adherence to mg/kg limits, according to the American Academy of Pediatrics 10
Procedure-Specific Volume Guidelines
- The American Society of Regional Anesthesia and Pain Medicine recommends the following typical volumes for peripheral nerve blocks and wound infiltration: 0.25% bupivacaine: 0.2-1.0 mL/kg depending on block type 10
- For epidural anesthesia, the American Society of Anesthesiologists recommends the following volumes: lumbar: 0.5 mL/kg of 0.25% (max 15 mL initially), and thoracic: 0.2-0.3 mL/kg of 0.25% (max 10 mL initially) 10
- For caudal block in pediatric patients, the American Academy of Pediatrics recommends 1.0 mL/kg of 0.25% bupivacaine 10