Levobupivacaine

Mechanism :

Levobupivacaine is a member of the amino amide class of local anesthetics. Local anesthetics block the generation and the conduction of nerve impulses by increasing the threshold for electrical excitation in the nerve, by slowing propagation of the nerve impulse, and by reducing the rate of rise of the action potential.

Indication :

Local anaesthesia
Epidural/intrathecal anaesthesia
Peripheral or Sympathetic nerve block
Pain management

Contraindications :

Contraindicated in patients with a known hypersensitivity to levobupivacaine or to any local anesthetic agent of the amide type, intravenous regional anaesthesia, severe hypotension, hypovolemia, paracervical block in obstetrics. Use with caution in liver disease, epilepsy, impaired cardiovascular function, respiratory impairment.

Dosing :

Not recommended for children under 12 years of age.

For children above 12 years:

Local Anaesthesia:

0.25% infiltration done locally; Max: 175 mg.

Caudal block:

15-30 ml of 0.25-0.5% drug which is free of preservatives.

Epidural Block:

10-20 ml of 0.25-0.5% solution in 3-5 ml increments allowing enough time for detection of accidental intravenous or intrathecal administration. It must be free of preservative. For purposes of surgery requiring higher degree of relaxation give 10-20 ml o

Peripheral Nerve block:

5 ml of 0.25-0.5% solution; Max: 400 mg/day.

Sympathetic Nerve Block:

20-50 ml of 0.25% drug.

Adverse Effect :

Inadvertent intrathecal administration can lead to spinal anaesthesia possibly with apnea, hypotension and unconsciousness that are life threatening. Accidental intravenous administration and excessive dosing may cause fatal anaphylactoid reactions, bradycardia, cardiac arrhythmias.

Interaction :

Vasopressor drugs and of Ergot-Type Oxytocic drugs: Cause severe, persistent hypertension or cerebrovascular accidents.
Phenothiazines and Butyrophenones: May reduce or reverse the pressor effect of epinephrine.

Hepatic Dose :

No dosage adjustments are recommended; use with caution in patients with liver disease.