Local Anaesthetic Dosing — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRegional AnaesthesiaLocal Anaesthetic DosingFRCA Final

A 55-year-old woman weighing 70 kg (ASA II), with normal hepatic and cardiac function, is to receive a single-shot bilateral ultrasound-guided transversus abdominis plane block. She has received no other local anaesthetic. What is the standard FRCA maximum weight-based dose of levobupivacaine that should be used when calculating the total dose for the block?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — 2 mg/kg

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as D · D = shown as E

B is correct. The standard FRCA weight-based maximum for levobupivacaine is 2 mg/kg. For this 70 kg patient, the calculated ceiling is 140 mg, equivalent to 56 mL of 0.25% levobupivacaine, divided between both sides rather than given per side. This also remains below the adult SmPC maximum single dose of 150 mg. The lowest dose that provides an effective block should still be selected because systemic absorption varies with the injection site and patient factors, and doses of any other local anaesthetics are additive. Adrenaline does not justify increasing the FRCA weight-based ceiling. Option A is unnecessarily restrictive as the standard maximum; options C–E exceed the accepted weight-based limit.

Reference: Royal College of Anaesthetists. Primary AKT Sample SBAs, Question 3 and explanation. 2025. https://www.rcoa.ac.uk/sites/default/files/documents/2025-11/Primary%20AKT%20Sample%20SBAs.pdf