Spinal Anesthesia Dosage Guidelines

Patient-Specific Considerations

• For patients weighing less than 40 kg, spinal anesthesia dosing should be carefully calculated based on weight, and for obese patients, ideal body weight should be used for calculations, with ideal body weight for men being height in cm - 100 and for women being height in cm - 105 1

Pediatric Dosing Guidelines

• For pediatric patients, spinal anesthesia is not recommended for those under 3 months unless absolutely necessary, and for those between 3-12 months and 1-5 years, dose calculation should be based on weight and procedure 2, 3
• The maximum dose for bupivacaine 0.25% in pediatric patients is 1 ml/kg (2.5 mg/kg), for levobupivacaine 0.25% is 1 ml/kg (2.5 mg/kg), and for ropivacaine 0.2% is 1.5 ml/kg (3 mg/kg) 2

Special Considerations

• For patients with coagulation disorders such as hemophilia, factor VIII/IX activity should be ≥50 IU/dL for mild bleeding history or ≥80 IU/dL for severe bleeding history before spinal anesthesia, and for those with fibrinogen deficiency, fibrinogen activity should be ≥1.5 g/L 4, 5
• Single-shot spinal anesthesia can be safely used with IV lidocaine due to the small dose of local anesthetic used, and intrathecal opioids can be safely used in conjunction with IV lidocaine 1, 6