levobupivacaine

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levobupivacaine

 [le″vo-bu-piv´ah-kān]
a local anesthetic used as the hydrochloride salt for local infiltration anesthesia, peripheral nerve block, and epidural anesthesia during surgical procedures and for postoperative pain management.

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.

levobupivacaine

a local anesthetic.
indications It is used for local and regional anesthesia, for pain management, and for continuous epidural analgesia.
contraindications Severe liver disease and known hypersensitivity to this drug contraindicate its use. It is also contraindicated in children less than 12 years of age and in the elderly.
adverse effects Life-threatening effects are convulsions, loss of consciousness, myocardial depression, cardiac arrest, arrhythmias, fetal bradycardia, status asthmaticus, respiratory arrest, and anaphylaxis. Other adverse effects include anxiety, restlessness, drowsiness, disorientation, tremors, shivering, bradycardia, hypotension, hypertension, nausea, vomiting, blurred vision, tinnitus, pupil constriction, rash, urticaria, allergic reactions, edema, burning, skin discoloration at the injection site, and tissue necrosis.

levobupivacaine

Chirocaine 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
Table 1: Onset and offset times of local anaesthetics
Type of local anaestheticOnset timeOffset time
Lidocaine5 minutes30-90 minutes
Bupivacaine20 minutes6-8 hours
Prilocaine5-10 minutes2-4 hours
Mepivacaine5-10 minutes2-4 hours
Levo-bupivacaine20-30 minutes6-8 hours
Ropivacaine5-10 minutes2-4 hours
Table 2: Principal drug interactions of local anaesthetic agents and other medications
Local anaesthetic agent Proprietary name Principal drug interactionsEffect of interaction
Lidocaine
Xylocaine
Antiarrhythmic agents
Antibacterial agents
Antipsychotics
Antivirals
Beta-blockers
Diuretics
Dolasetron
Ulcer-healing drugs
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
Bupivacaine
Marcain
Levo-bupivacaine
Chirocaine
Beta-blockersIncreased risk of bupivacaine toxicity when given with propranolol
Increased risk of myocardial depression if given with other antiarrhythmic agents
Prilocaine
Citanest
Antiarrhythmic agents
Antibacterial agents
Increased risk of myocardial depression if given with antiarrhythmic agents
Increased risk of methaemoglobinaemia if given with sulphonamide antibacterial agents
Ropivacaine
Naropin
AntidepressantsMetabolism of ropivacaine is inhibited by fluvoxamine, thereby enhancing the risk of ropivacaine toxicity
Mepivacaine
Scandonest
Drug not listed in the British National Formulary
Table 3: Maximum safe doses of plain local anaesthetic agents (for 70Kg adult in 24 hours)
Agent (brand name)Maximum safe dose (70-kg adult)Dose per kg of body mass
Lidocaine (Xylocaine)200mg3mg/kg
Bupivacaine (Marcain)150mg2mg/kg
Levo-bupivacaine (Chirocaine)150mg2mg/kg
Mepivacaine (Scandonest)400mg6mg/kg
Prilocaine (Citanest)400mg6mg/kg
Ropivacaine (Naropin)250mg3.5mg/kg
Table 4: Calculation of the combined maximum safe doses (MSDs) of plain local anaesthetic agents
Mass of drug administeredAmount of drugs administered in relation to proportional MSDsPercentage of combined MSD
e.g. 70-kg adult
Agent 1
6mL lidocaine 2%
120mgEquivalent to (120/200) × 100% = 60% of MSD lidocaine77%
Agent 2
5mL bupivacaine 0.5%
25mgEquivalent to (25/150) × 100% = 17% of MSD bupivacaine
e.g. 40-kg child
Agent 1
4mL lidocaine 2%
80mgEquivalent to (80/120) × 100% = 77% of MSD lidocaine89.5%
Agent 2
2mL bupivacaine 0.5%
10mgEquivalent 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%.

References in periodicals archive ?
Contract notice: NHS National Framework Generic Products Ceftazidime, Epoprostenol, Busulfan, Levobupivicaine, Remifentanil.