Revised 8/26/06                                                 DIFFERENT EPIDURAL AND SPINAL DRUG REGIMENS CURRENTLY USED

                                     (The concentration, dose and infusion rates are given only for guidance; Copyright S.Ramanathan, M.D.)

Type of Epidural

Lido+Epi test dose

Initiation (Loading)

Infusion

Narcotic

PCEA (PCA) parameters

 

 

Concent (%)

Volume (ml)

Concent (%)

ml/Hour

Bolus

(100 ug)

Infusion (mcg/ml)

Basal rate (ml)

PCEA  dose (ml)

Lock-out

(min)

Max/Hr

(ml)

Conventional Bupivacaine

Yes

0.25

 10

0.125

10

 Fentanyl

2

 

 

 

 

Conventional Ropivacaine

Yes

0.2

10-15 ml

0.1

12-15

Fentanyl

2

 

 

 

 

Dilute Conventional Bupivacaine

Yes

0.125%

10-15 ml

0.125%

10-12

Fentanyl

2

 

 

 

 

Walking epidural - Bupi

No

0.04

15 ml

0.04

15 ml

Fentanyl

2

 

 

 

 

Walking epidural - Ropi

No

0.07

15-20 ml

0.07

15-18

Fentanyl

2

 

 

 

 

Ropi PCEA

Yes

0.2%

10-15 ml

0.1%

 

Fentanyl

2

8-9.9

8

30

24

Bupi or Chiro - PCEA

Yes

0.25%

10

0.125

 

Fentanyl

2

8-9.9

8

30

24

Supplemental doses for

inadequate pain relief

Lidocaine 5 ml 1.5% with epi; Fentanyl 100 ug epidurally; Pump bolus 10-15 ml

 

Intermittent  Bupi,Ropi, Chirocaine (no infusion)

Yes

0.25

10 ml

 

 

Fentanyl

 

 

 

 

 

Intermittent Lidocaine (Epi)

Yes

1.5

6 ml

 

 

 

 

 

 

 

 

Cedars Bupivacaine PCEA

No

0.25

9

 

 

Fentanyl

2

12

12

30

36 ml

CSE -fentanyl+

(bupi 0.25% - 1ml) or

Ropi 0.2% 1.5 ml) or Chiro (0.25%)  1 ml

?

 

 

 

 

fentanyl

25 ug

 

 

 

 

 

CSE -sufent.(bupi 0.25% - 1ml) or

Ropi 0.2% 1.5 ml)

 

 

 

 

 

sufentanil 

5-7.5 ug

 

 

 

 

 

I.V. PCA Fentanyl (pulse ox)

 

10 mcg/ml

5-10 ml

 

 

Fentanyl

 

2 ml/hr

2 ml

5

25 ml /1 hr

IV Remifentanil  iinfusion

(Side-effets). (pulse ox)

 

 

 

 

 

 

None

20 ug in

20 sec

3 min

 

Spinal anesthesia for C.S

 

Bupi 0.75%+8.25%dext 12-14 mg +fent 20-25 ug+Morphine 200 mcg (hyperbaric)