Levobupivacaine: a new safer long acting local anaesthetic agent

Abstract

The choice of local anaesthetic is influenced by several factors; it must provide effective anaesthesia and analgesia for the duration of the procedure and meet the expectations for post-operative pain management. Of primary concern is patient safety. Bupivacaine, currently the most widely used long acting local anaesthetic agent in both surgery and obstetrics, generally has a good safety record but its use has resulted in fatal cardiotoxicity, usually after accidental intravascular injection. Hence, for several years there has been a need for a long acting local anaesthetic, similar to bupivacaine, but with an improved cardiovascular safety profile. Levobupivacaine, the single enantiomer version of bupivacaine, offers a new long acting local anaesthetic, clinically equivalent in anaesthetic potency to bupivacaine, but with a reduced toxicity profile. Preclinical studies, from in vitro in single ion channels to whole large animal models, have unquestionably demonstrated that levobupivacaine is significantly less CNS toxic and cardiotoxic than bupivacaine. Cardiotoxicity is less easy to study in man, as the clinical signs are not usually seen until the CNS toxicity is marked, and well beyond that which is tolerable to volunteers or patients. Nevertheless, levobupivacaine has been shown to have less effect on myocardial contractility and QTc prolongation, early signs of cardiotoxicity, than bupivacaine in healthy subjects. In clinical use levobupivacaine has been shown to be equally efficacious as bupivacaine at comparable doses and concentrations, and has been found to produce similar anaesthetic characteristics (onset, duration and density of block). As levobupivacaine now becomes commercially available, the database available with which to make efficacy and safety comparisons with other local anaesthetics will increase, and the true value of this new long acting local anaesthetic should become even more apparent.

Levobupivacaine versus racemic bupivacaine: a comparative study on spinal anaesthesia in lower limb surgeries

“…4 Although, levobupivacaine has very similar pharmacological properties to racemic bupivacaine, it is noted for lower toxicity. 5 In present study in Tables 1-4 we have compared the two forms of bupivacaine and found in Table 5, that incidence of side effects especially hypotension was observed. Hypotension was observed in 2 and 3 cases of Group L and Group R respectively.…”

“…3 Many drugs including epinephrine, opioids, clonidine, ketamine, midazolam and neostigmine have been tried as adjuvants with caudal bupivacaine to improve the quality of analgesia and extend its duration but each of these has its own documented adverse effects. [4][5][6] The primary aim of this study was to compare the pharmacological anaesthetic efficacy of levobupivacaine with bupivacaine and observe the risk of cardiotoxicity and neurotoxicity.…”

Comparison of intraarticular bupivacaine and levobupivacaine injection in rat synovial inflammation

“…Levobupivacaine is a longlasting LA with an S(-) isomer of bupivacaine and an amide structure. As with all LA agents, levobupivacaine functions by altering voltage-sensitive channels in neural membranes (3). Understanding the histopathological effects of intraarticularly injected LAs is critical as they may alter the joint cartilage and the synovium (5).…”

Can a Periarticular Levobupivacaine Injection Reduce Postoperative Opiate Consumption During Primary Hip Arthroplasty?

“…Levobupivacaine is a long-acting local anesthetic in common use, and as a single enantiomer of bupivacaine (rather that a racemic mixture), it has a relatively low risk of cardiac and central nervous system side effects [6,12]. However, as all previous studies used combinations of agents, it is unclear whether isolated use of periarticular infiltration of a local anesthetic agent at the time of surgery provides pain relief or reduces the frequency of complications.…”