AdultUrological surgery 1.5-3 mL. Surgery on lower limb (including hip surgery) & abdominal (including caesarean section) 2-4 mL. Recommended inj site is the L3-L4 intervertebral space. Max dose: 20 mg.
Hypersensitivity to local anaesth of the amide type. Diseases of the CNS (eg, meningitis, poliomyelitis, intracranial haemorrhage). Local pyogenic infection at or adjacent to the inj site. Spinal stenosis & active disease (eg, spondylitis, tumour) or trauma (eg, fracture of the spine). Septicaemia. Pernicious anaemia w/ subacute degeneration of the spinal cord. Should not be given to patients in shock; w/ coagulation disorders or receiving ongoing anticoagulation treatment.
Patients w/ degree II or III AV block; severe hepatic disease, severely impaired renal function or reduced general condition. Closely observe & consider ECG monitoring in patients treated w/ class III anti-arrhythmics (eg, amiodarone) since cardiac effects can be additive. Acute central nervous & CV toxic effects. Ventricular arrhythmia/fibrillation, sudden CV collapse & death in association w/ high systemic conc of bupivacaine. Extensive or total spinal blockade resulting to CV & resp depression. Intrathecal anaesth may lead to hypotension & bradycardia. Neurological damage resulting to paraesthesia, anaesth, motor weakness & paralysis. Pregnancy & lactation. Elderly.
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