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levobupivacaine/le·vo·bu·piv·a·caine/ (le″vo-bu-piv´ah-kān) the S enantiomer of bupivacaine; a local anesthetic used as the hydrochloride salt for local infiltration anesthesia, peripheral nerve block, and epidural anesthesia.
levobupivacaineChirocaine™ Anesthesiology A long-acting local anesthetic used for pain during childbirth, surgery. See Chiral chemistry.
levobupivacaine; Chirocaine isomer of bupivacaine, with similar anaesthetic and analgesic properties, but with less adverse effects; contraindicated for Bier's block anaesthesia; Table 1and Table 2; see Table 3and Table 4
|Type of local anaesthetic||Onset time||Offset time|
|Lidocaine||5 minutes||30-90 minutes|
|Bupivacaine||20 minutes||6-8 hours|
|Prilocaine||5-10 minutes||2-4 hours|
|Mepivacaine||5-10 minutes||2-4 hours|
|Levo-bupivacaine||20-30 minutes||6-8 hours|
|Ropivacaine||5-10 minutes||2-4 hours|
|Local anaesthetic agent Proprietary name||Principal drug interactions||Effect of interaction|
|Increased myocardial depression|
Increased risk of ventricular arrhythmias if lidocaine is given with quinpristin/dalfopristin
Increased risk of ventricular arrhythmias if lidocaine is given with any drug that prolongs the QT interval of the cardiac cycle
Plasma concentration of lidocaine increased by amprenavir, atazanavir and lopinavir
Increased myocardial depression
Increased risk of lidocaine toxicity when given with propranolol
The action of lidocaine is antagonized by the hypokalaemia caused by acetazolamide, loop diuretics or thiazide and related diuretics (i.e. a greater dose of lidocaine would be required to achieve anaesthesia)
Increased risk of ventricular arrhythmia if lidocaine is given with dolasetron
Plasma concentration of lidocaine increased when given with cimetidine; risk of lidocaine toxicity increased with cimetidine
|Beta-blockers||Increased risk of bupivacaine toxicity when given with propranolol|
Increased risk of myocardial depression if given with other antiarrhythmic agents
|Increased risk of myocardial depression if given with antiarrhythmic agents|
Increased risk of methaemoglobinaemia if given with sulphonamide antibacterial agents
|Antidepressants||Metabolism of ropivacaine is inhibited by fluvoxamine, thereby enhancing the risk of ropivacaine toxicity|
|Drug not listed in the British National Formulary|
|Agent (brand name)||Maximum safe dose (70-kg adult)||Dose per kg of body mass|
|Mass of drug administered||Amount of drugs administered in relation to proportional MSDs||Percentage of combined MSD|
|e.g. 70-kg adult|
| Agent 1 |
6mL lidocaine 2%
|120mg||Equivalent to (120/200) × 100% = 60% of MSD lidocaine||77%|
| Agent 2 |
5mL bupivacaine 0.5%
|25mg||Equivalent to (25/150) × 100% = 17% of MSD bupivacaine|
|e.g. 40-kg child|
| Agent 1 |
4mL lidocaine 2%
|80mg||Equivalent to (80/120) × 100% = 77% of MSD lidocaine||89.5%|
| Agent 2 |
2mL bupivacaine 0.5%
|10mg||Equivalent to (10/80) × 100% = 12.5% of MSD bupivacaine|
Where more than one anaesthetic agent is injected in order to achieve both rapid anaesthesia and prolonged postoperative pain relief, the proportional MSD of each of the anaesthetic agents should be calculated, in order not to exceed the combined MSD.
The calculation is the product of the patient's body mass, the percentage mass of the individual anaesthetic agent and the total volume used of each local anaesthetic drug.
In the examples cited in this table, safe doses of anaesthesia would have been administered, as the combined doses of each anaesthetic does not exceed 100%.