Neuraxial Drug Card

Question 1

Bicarb epidural bolus dose

Answer 1

1 mEq/10 mL local anesthetic

Question 2

Chloroprocaine (Nesacaine) epidural bolus dose, T4 dose, epidural onset

Answer 2

Bolus dose: 5mL 3% (150mg)
T4 dose: 10-20 mL 3% (300-600mg)
Epidural onset: fastest

Question 3

Ropivacaine (Naropin) epidural bolus bose, infusion rate, onset

Answer 3

Bolus: 5-10 mL 0.2% (10-20mg)
Infusion: 6-14 mL/hr 0.2%
Onset: 10-15 minutes

Question 4

Lidocaine (xylocaine) epidural bolus, T4 dose, onset

Answer 4

Bolus: 5mL 2% (100mg)
T4: 10-20 mL 2% (200-400mg)
Onset: few minutes

Question 5

Bupivacaine (marcaine) epidural bolus, infusion, onset

Answer 5

Bolus: 5-10mL (0.125%)
Infusion: 8-15mL/hr (0.125%)
Onset: 10-15 min

Question 6

Fentanyl epidural bolus, infusion

Answer 6

Bolus: 50mcg
Infusion: 1mcg/mL in infusion bag

Question 7

Sufentanil epidural bolus

Answer 7

10-15 mcg

Question 8

Duramorph epidural bolus

Answer 8

2-4mg

Question 9

Epinephrine epidural infusion rate

Answer 9

1-2mcg/mL in infusion bag

Question 10

1% tetracaine (pontocaine) spinal dose and duration

Answer 10

Dose: 
-1 mL (10mg) for T10
-1.2-1.6 mL (12-16mg) for T4
Duration: 2-3 hours w/o epi
up to 6 hours w/epi

Question 11

5% lidocaine (xylocaine) spinal dose and duration

Answer 11

Dose:
-1-1.5mL (50-75mg) for T10
-1.5-2mL (75-100mg) for T4
Duration:
-60 min w/o epi
-90 min w/epi

Question 12

0.75% bupivacaine (marcaine) spinal dose and duration

Answer 12

Dose:
-1.4-1.6 mL (10-12mg) for C-section
-0.8mL (6mg) for vaginal delivery
Duration:
-2hrs w/o epi
-2.5 hrs w/epi

Question 13

Fentanyl spinal dose and duration

Answer 13

Dose: 5-25mcg (added to local anesthetic)
Duration: 3-4 hours

Question 14

Sufentanil spinal dose

Answer 14

Dose: 10mcg (not added to local)

Question 15

Duramorph spinal dose and duration

Answer 15

Dose: 0.2-0.4mg
Duration: 12-24 hours

Question 16

Epinephrine spinal dose

Answer 16

Dose: 200-300mcg

Question 17

Phenylephrine spinal dose

Answer 17

2-5mg

Question 18

Clonidine spinal dose

Answer 18

75-150mg

Question 19

How long should you wait after the last Plavix dose to attempt a block?

Answer 19

7 days

Question 20

How long from the last Plavix dose should you wait before an epidural catheter can be removed?

Answer 20

5-7 days

Question 21

How long should you wait from the last dose of Coumadin to do a block?

Answer 21

5 days, or INR <1.4

Question 22

How long from the last Coumadin dose should you wait before an epidural catheter can be removed?

Answer 22

INR <1.4

Question 23

How long should you wait from the last dose of Heparin to do a block?

Answer 23

4 hours, or normal PTT

Question 24

How long should you wait from the last dose of Lovenox to do a block?

Answer 24

12 hours for normal doses, 24 hours for higher doses

Question 25

How long should you wait from the last dose of Aspirin/NSAIDs to do a block?

Answer 25

Should not interfere with blocks

Question 26

How long from the last Heparin dose should you wait before an epidural catheter can be removed?

Answer 26

4 hours, or normal PTT

Question 27

How long from the last Lovenox dose should you wait before an epidural catheter can be removed?

Answer 27

12-24 hours

Question 28

How long from the last aspirin/NSAIDs dose should you wait before an epidural catheter can be removed?

Answer 28

Should not interfere

Question 29

How long should you wait to resume dosing heparin after a block was performed?

Answer 29

> 1hr

Question 30

How long should you wait to resume dosing Lovenox after a block was performed?

Answer 30

24 hours

Question 31

How long should you wait after removing an epidural catheter to resume dosing heparin?

Answer 31

> 1hr

Question 32

How long should you wait after removing an epidural catheter to resume dosing Lovenox?

Answer 32

> 2 hours

Question 33

Used for marcaine toxicity

Answer 33

Intralipid 20%

Question 34

Dose and infusion of intralipid 20%

Answer 34

Dose: 1.5-3mL/kg IV
Max dose 8 mL/kg
Infusion: 0.25-0.5 mL/kg/min IV