Clinical profile of levobupivacaine in regional anesthesia: A systematic review

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.

Efficacy of Intrathecal Levobupivacaine and Bupivacaine for Caesarean Section- A Comparative Study

“…Our observation is similar to the results of Bajwa SS et al [6] , who in their study of Clinical profile of levobupivacaine in regional anaesthesia found that the time to onset of sensory and maximum motor block as well as the duration of analgesia is slightly longer with intrathecal levobupivacaine as compared to bupivacaine in caesarean section. In 2014, Del-Rio Vellosilo et al .…”

Comparison of two different doses of magnesium sulphate for spinal anaesthesia: a prospective, randomized double-blind study

“…Levobupivacaine has been found to be equally efficacious as bupivacaine, but with a superior pharmacokinetic profile and less cardiac and neurological toxic adverse effects. 3,4 Various intrathecal adjuvants are being used with local anaesthetics for prolongation of the duration and quality of block. However, there is limited benefit either due to the adverse effects or unreliable post-operative analgesia.…”

A clinical comparative study of 0.2% levobupivacaine with 25 mcg fentanyl versus 0.2% ropivacaine with 25 mcg fentanyl for post-operative epidural analgesia in patients undergoing lower limb orthopaedic surgeries

“…This can be evidenced by the fact that equal doses of both Levobupivacaine and Bupivacaine provide same duration of analgesia (4-6hr) but with a better clinical safety with Levobupivacaine. 16 However, the median duration of analgesia when 0.5% Ropivacaine was injected for surgery was 1.7-4.2 hours. 22 This can be further substantiated by studies conducted by Peduto et al 8 Kara et al 21 Senard et al 23 Rao et al 10 Brown et al 24 Morrison et al 18 where the duration of analgesia produced by Ropivacaine is much lesser in comparison to Levobupivacaine.…”

“…16 The quality of pain relief from low-dose epidural infusions of plain local anaesthetic consistently benefits from the addition of adjuvants such as opioids (Hubler et al, 2001, 25 Senard et al 2002 23 ) or alpha-2 adrenoceptor agonists. Potential dose-sparing benefits are more obvious for local anaesthetic side effects (hypotension and motor block) than for opioid-related side effects.…”