OB-GYN 101
Pharmacy

Category:

• Local anesthetic

Description:

• Local anesthetic

Indications:

• Infiltration and peripheral nerve block

• Central nerve block including lumbar and caudal epidural blocks (without preservatives)

Contraindications:

• Hypersensitivity to drugs of the PABA ester group

Precautions:

• Pregnancy category C

• Lumbar and caudal epidural anesthesia should be used with extreme caution inpersons with the following conditions: existing neurological disease, spinal deformities, septicemia, and severe hypertension

Adverse Reactions (Side Effects):

• CNS: anxiety, disorientation, drowsiness, loss of consciousness, restlessness, seizures

• CV: bradycardia, cardiac arrest, dysrhythmias, myocardial depression, hypotension, hypertension

• EENT: blurred vision, pupil constriction, tinnitus

• RESP: respiratory arrest, status asthmaticus

• SKIN: allergic reactions, burning, edema, rash, skin discoloration at injection site, tissue necrosis, urticaria

Administered via injection

• Adult:   

  • Max single recommended doses without epinephrine:

    • 11 mg/kg

    • not to exceed a max total dose of 800mg; 

  • with epinephrine (1:200,000) 

    • 14 mg/kg

    • not to exceed a max total dose of 1000mg

  • Lumbar and caudal epidural block: 

    • 15-25ml of a 2% or 3% preservative-free solution

    • repeated doses may be given at 40-60 minute intervals

  • Infiltration and peripheral nerve block (1-2%): 

    • Mandibular 2-3 ml

    • infraorbital 0.5-1 ml

    • brachial plexus 30-40 ml

    • digital (without epinephrine) 3-4 ml

    • pudendal 10 ml each side

    • paracervical 3 ml per each of up to 4 sites

  • Lumbar epidural anesthesia: 

    • 15-25 ml

    • repeated doses 10-20 ml at 40-50 minute intervals

• Child > 3 years:  

  • Max single recommended dose 11 mg/kg