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Bupivacaine Maximum Dose — FRCA Primary MCQ

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HardPharmacology - AnalgesicsBupivacaine Maximum DoseFRCA Primary

A 70 kg patient develops seizures followed by ventricular arrhythmia immediately after an interscalene injection of bupivacaine. Airway support and modified ALS are underway. Which initial 20% lipid-emulsion regimen matches current UK guidance?

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Correct answer: B — Give 105 mL intravenously as a bolus, then begin 1,050 mL h−1

The best answer is “Give 105 mL intravenously as a bolus, then begin 1,050 mL h−1”. The UK regimen is a 1.5 mL kg−1 bolus followed by 15 mL kg−1 h−1. For 70 kg, those values are 105 mL and 1,050 mL h−1. This calculation sits within a broader response: stop local anaesthetic, correct hypoxia and acidosis, use reduced adrenaline doses, repeat lipid as directed and respect the cumulative limit.

Reference: Resuscitation Council UK 2025 Special circumstances guidelines: local anaesthetic systemic toxicity: https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/special-circumstances-guidelines; Royal College of Anaesthetists, Primary FRCA syllabus v2.2: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf