Ultrasound Blocks for the Anterior Abdominal Wall

12. Local Anesthetics, Pharmacokinetics and Adjuvants | 85
Table 12.1 – Dose, volume and concentration correlations.
C = Concentration (mg/ml)
M = Mass (mg)
V = Volume (ml)
C = M / V
M = C x V
V = M / C
The right approach to a local anesthetic dosing is to calculate
the dose per kg of weight and to dilute it in order to obtain the
desired volume or concentration. The total dose (the product of
volume x concentration) should be tailored to the minimum
mass of local anesthetic necessary to achieve the desired clinical
effect (Table 12.2, 12.3, 12.4).
Table 12.2 – Recommended doses of the long-lasting local anesthetics.
Recommended doses Ropivacaine Levobupivacaine Bupivacaine
Adults 2-3.5 mg/kg 2-3 mg/kg 2-3 mg/kg
Children dose 1-3 mg/kg 1-2 mg/kg 1-2 mg/kg
Children volume 0.075-0.5 ml/kg 0.075-0.5 ml/kg 0.075-0.5 ml/kg
Table 12.3 - Maximum recommended doses of the long-lasting local
anesthetics in adults.
Local anesthetic
Ropivacaine
Levobupivacaine
Bupivacaine
Infiltration anesthesia
(doses with epinephrin are in brackets)
200-225 mg
150 mg
150-175 (225) mg
Table 12.4 – Concentration ranges of the long-lasting local anesthetics
for infiltration and nerve block anesthesia.
Recommended concentrations Ropivacaine Levobupivacaine Bupivacaine
Adults 2-7.5 mg/ml 1.25-5 mg/ml 1.25-5 mg/ml
Children 1-7.5 mg/ml 1-5 mg/ml 1.25-5 mg/ml