Clinical Profile of Levobupivacaine in Regional Anesthesia: A Systematic Review

Overview

Journal J Anaesthesiol Clin Pharmacol

Specialty Anesthesiology

Date 2013 Nov 20

PMID 24249993

Citations 28

Authors

Sukhminder Jit Singh Bajwa

Jasleen Kaur

Affiliations

Soon will be listed here.

Abstract

The quest for searching newer and safer anesthetic agents has always been one of the primary needs in anesthesiology practice. Levobupivacaine, the pure S (-)-enantiomer of bupivacaine, has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling, bupivacaine. Levobupivacaine has been found to be equally efficacious as bupivacaine, but with a superior pharmacokinetic profile. Clinically, levobupivacaine has been observed to be well-tolerated in regional anesthesia techniques both after bolus administration and continuous post-operative infusion. The incidence of adverse drug reactions (ADRs) is rare when it is administered correctly. Most ADRs are related to faulty administration technique (resulting in systemic exposure) or pharmacological effects of anesthesia; however, allergic reactions can also occur rarely. The available literary evidence in anesthesia practice indicates that levobupivacaine and bupivacaine produce comparable surgical sensory block, similar adverse side effects and provision of similar labor analgesia with good comparable maternal and fetal outcome. The present review aims to discuss the pharmacokinetic and pharmacological essentials of the safer profile of levobupivacaine as well as to discuss the scope and indications of levobupivacaine based on current clinical evidence.

Citing Articles

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References

Peduto V, Baroncini S, Montanini S, Proietti R, Rosignoli L, Tufano R . A prospective, randomized, double-blind comparison of epidural levobupivacaine 0.5% with epidural ropivacaine 0.75% for lower limb procedures. Eur J Anaesthesiol. 2003; 20(12):979-83. DOI: 10.1017/s0265021503001583. View

Wang L, Chang X, Liu X, Hu X, Tang B . Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia during labor: a randomized clinical trial. Chin Med J (Engl). 2010; 123(2):178-83. View

Zeren S, Kesici S, Kesici U, Isbilir S, Turkmen U, Ulusoy H . Effects of levobupivacaine on wound healing. Anesth Analg. 2013; 116(2):495-9. DOI: 10.1213/ANE.0b013e318273f48e. View

Cline E, Franz D, Polley R, Maye J, Burkard J, Pellegrini J . Analgesia and effectiveness of levobupivacaine compared with ropivacaine in patients undergoing an axillary brachial plexus block. AANA J. 2004; 72(5):339-45. View

De Negri P, Ivani G, Tirri T, Modano P, Reato C, Eksborg S . A comparison of epidural bupivacaine, levobupivacaine, and ropivacaine on postoperative analgesia and motor blockade. Anesth Analg. 2004; 99(1):45-48. DOI: 10.1213/01.ANE.0000120162.42025.D0. View

Camorcia M, Capogna G, Lyons G, Columb M . Epidural test dose with levobupivacaine and ropivacaine: determination of ED(50) motor block after spinal administration. Br J Anaesth. 2004; 92(6):850-3. DOI: 10.1093/bja/aeh155. View

Urbanek B, Duma A, Kimberger O, Huber G, Marhofer P, Zimpfer M . Onset time, quality of blockade, and duration of three-in-one blocks with levobupivacaine and bupivacaine. Anesth Analg. 2003; 97(3):888-892. DOI: 10.1213/01.ANE.0000072705.86142.5D. View

MEBUST W, HOLTGREWE H, COCKETT A, Peters P . Transurethral prostatectomy: immediate and postoperative complications. Cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol, 141: 243-247, 1989. J Urol. 2001; 167(1):5-9. DOI: 10.1016/s0022-5347(05)65370-0. View

Foxall G, McCahon R, Lamb J, Hardman J, Bedforth N . Levobupivacaine-induced seizures and cardiovascular collapse treated with Intralipid. Anaesthesia. 2007; 62(5):516-8. DOI: 10.1111/j.1365-2044.2007.05065.x. View

10.

Crews J, Hord A, Denson D, Schatzman C . A comparison of the analgesic efficacy of 0.25% levobupivacaine combined with 0.005% morphine, 0.25% levobupivacaine alone, or 0.005% morphine alone for the management of postoperative pain in patients undergoing major abdominal surgery. Anesth Analg. 1999; 89(6):1504-9. DOI: 10.1097/00000539-199912000-00035. View

11.

Ghali A . The efficacy of 0.75% levobupivacaine versus 0.75% ropivacaine for peribulbar anesthesia in vitreoretinal surgery. Saudi J Anaesth. 2012; 6(1):22-6. PMC: 3299109. DOI: 10.4103/1658-354X.93050. View

12.

Demiraran Y, Albayrak M, Yorulmaz I, Ozdemir I . Tramadol and levobupivacaine wound infiltration at cesarean delivery for postoperative analgesia. J Anesth. 2012; 27(2):175-9. DOI: 10.1007/s00540-012-1510-7. View

13.

Cuvas O, Basar H, Yeygel A, Turkyilmaz E, Sunay M . Spinal anesthesia for transurethral resection operations: levobupivacaine with or without fentanyl. Middle East J Anaesthesiol. 2010; 20(4):547-52. View

14.

Burm A, van der Meer A, Van Kleef J, Zeijlmans P, Groen K . Pharmacokinetics of the enantiomers of bupivacaine following intravenous administration of the racemate. Br J Clin Pharmacol. 1994; 38(2):125-9. PMC: 1364857. DOI: 10.1111/j.1365-2125.1994.tb04335.x. View

15.

Frawley G, Downie S, Huang G . Levobupivacaine caudal anesthesia in children: a randomized double-blind comparison with bupivacaine. Paediatr Anaesth. 2006; 16(7):754-60. DOI: 10.1111/j.1460-9592.2006.01841.x. View

16.

Kopacz D, Allen H, Thompson G . A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg. 2000; 90(3):642-8. DOI: 10.1097/00000539-200003000-00026. View

17.

Huang Y, Pryor M, Mather L, Veering B . Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg. 1998; 86(4):797-804. DOI: 10.1097/00000539-199804000-00023. View

18.

Weinberg G . Treatment of local anesthetic systemic toxicity (LAST). Reg Anesth Pain Med. 2010; 35(2):188-93. DOI: 10.1097/AAP.0b013e3181d246c3. View

19.

Milligan K, Convery P, Weir P, Quinn P, Connolly D . The efficacy and safety of epidural infusions of levobupivacaine with and without clonidine for postoperative pain relief in patients undergoing total hip replacement. Anesth Analg. 2000; 91(2):393-7. DOI: 10.1097/00000539-200008000-00030. View

20.

McLeod G, Burke D . Levobupivacaine. Anaesthesia. 2001; 56(4):331-41. DOI: 10.1046/j.1365-2044.2001.01964.x. View