Local Anesthetic Dosing

Author: The Cardiac Anesthesiologist

General recommendations for average volumes of local anesthetic for specific blocks are found in Table 1. In all cases one must never exceed  the  recommended toxic limits of local anesthetic (Table 2), which should be calculated in advance and must also take into account any addition local anesthetic dose administered to the patient by the anesthesiologist or surgeon . Local anesthetic systemic toxicity is a rare event during peripheral nerve blockade but must be assiduously avoided.

Area of block	Suggested   volume (mL/kg)	Postoperative   analgesic dose	Anesthetic dose	Max dose (mL)
Above umbilicus	0.2–0.4	0.2% Ropivacaine or 0.25%  bupivacaine	0.35% Ropivacaine or 0.375% bupivacaine	30
Below umbilicus	0.3–0.5	0.2% Ropivacaine or 0.25%  bupivacaine	0.35% Ropivacaine or 0.375% bupivacaine	40
Compartment block (TAP, quadratus lumborum, paravertebral)	0.25	0.2% Ropivacaine or 0.25%  bupivacaine	Surgical anesthetic dose cannot be obtained (not applicable)	40