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[Local anesthetics--maximum recommended doses]

H C Niesel1

  • 1Anästhesie-Abteilung, St. Marien- und St. Annastiftskrankenhaus Ludwigshafen/Rhein.

Anaesthesiologie Und Reanimation
|January 1, 1997
PubMed
Summary
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Current maximum doses for local anesthetics overlook pharmacokinetic and toxicological data, leading to varied recommendations based on regional anesthesia techniques. Adjusting doses for specific patient factors and administration methods is crucial for safe and effective local anesthesia.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Toxicology

Background:

  • Existing maximum dose recommendations for local anesthetics do not account for critical pharmacokinetic and toxicological data.
  • Factors such as regional anesthesia technique and inadvertent intravascular injection of solutions containing epinephrine significantly influence drug levels and toxicity.

Purpose of the Study:

  • To establish revised maximum dose recommendations for local anesthetics based on administration techniques.
  • To highlight the importance of considering patient-specific factors and regional anesthesia methods for safe drug administration.

Main Methods:

  • Categorization of regional anesthesia techniques into five types (subcutaneous, high absorption, single injection, protracted injection, near spinal cord).
  • Determination of maximum recommended doses for mepivacaine, lidocaine, prilocaine, bupivacaine, and etidocaine for each technique, with and without epinephrine.

Related Experiment Videos

  • Consideration of specific risks associated with injections near the spinal cord and limitations for epinephrine-containing solutions.

    • Main Results:

    • Maximum recommended doses vary significantly across different regional anesthesia techniques, with lower doses for areas of high absorption and higher doses for protracted injections.
    • For prilocaine, bupivacaine, and etidocaine, maximum doses remain consistent whether or not adrenaline is included, with epinephrine solutions limited by total adrenaline content.
    • Specific dose ranges are provided for injections near the spinal cord, emphasizing the high risks even with small volumes.

    Conclusions:

    • Maximum dose recommendations for local anesthetics must be individualized based on patient weight, condition, and the chosen regional anesthesia technique.
    • The provided maximum doses are guidelines and not absolute limits, underscoring the need for careful patient monitoring and dose adjustment.
    • Ropivacaine does not have a quantitative limit due to its long-acting nature and recommended administration techniques.