Local Anaesthetic (Amide — S-Enantiomer) Pregnancy: Contraindicated for paracervical block in obstetrics (risk of foetal bradycardia). No clinical data in first-trimester pregnancies; should not be given in early pregnancy unless clearly necessary. Likely poorly transmitted in breast milk, so breastfeeding is possible after local anaesthesia.

Levobupivacaine

Brand names: Chirocaine

Levobupivacaine is a long-acting amide local anaesthetic — the S-enantiomer of bupivacaine — used for surgical anaesthesia, regional blocks, and post-operative analgesia.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Epidural infusion of 1.25 mg/ml solution: post-operative pain 10-15 ml/hour (12.5-18.75 mg/hour); labour analgesia (lumbar epidural) 4-10 ml/hour (5-12.5 mg/hour)

Route: Epidural infusion only (must NOT be given intravenously)

Frequency: Continuous infusion

Max: Maximum 400 mg over any 24-hour period; post-operative pain management dose not to exceed 18.75 mg/hour; labour analgesia by epidural infusion not to exceed 12.5 mg/hour

The 1.25 mg/ml solution for infusion is for epidural use only and must not be used for intravenous administration. Maximum dosage must be determined by the patient's size and physical status. Limited safety experience for periods exceeding 24 hours. Debilitated, elderly or acutely ill patients should be given reduced doses commensurate with physical status; in post-surgery pain, account for the dose given during surgery. Careful aspiration before infusion to prevent intravascular injection; stop the injection immediately if toxic symptoms occur. No relevant data in hepatic impairment. Should be administered only by, or under supervision of, a suitably trained and experienced clinician.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Known hypersensitivity to levobupivacaine, amide-type local anaesthetics or any excipient
Intravenous regional anaesthesia (Bier's block)
Severe hypotension such as cardiogenic or hypovolaemic shock
Paracervical block in obstetrics
General contraindications to regional anaesthesia should also be taken into account

Side effects

Hypotension (very common)
Anaemia (very common)
Nausea and vomiting
Dizziness and headache
Pyrexia, back pain and procedural pain
Foetal distress syndrome (in obstetric use)

Clinical monograph

How it works

It reversibly blocks voltage-gated sodium channels in nerve membranes, preventing depolarisation and the propagation of nerve impulses.

Prescribing in practice

Inadvertent intravascular injection can cause cardiac arrest and central nervous system toxicity; aspirate before injecting, use incremental dosing, and have lipid emulsion and resuscitation facilities available.
It has a more favourable cardiotoxicity profile than racemic bupivacaine but the same precautions against systemic toxicity apply.
It must never be used for intravenous regional anaesthesia (Bier's block).

Monitoring

Monitor cardiovascular and neurological status during and after injection for signs of local anaesthetic systemic toxicity.

Counselling the patient

The treated area will feel numb and weak until the block resolves; protect it from injury.
Report any dizziness, ringing in the ears, a metallic taste, or numbness around the mouth immediately.

Evidence & guidelines

Use is supported by product information and regional anaesthesia practice; refer to current prescribing references and the SPC.

Reference: AAGBI LAST Guidelines 2023; OAA (Obstetric Anaesthetists Association) Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Ropivacaine · Local Anaesthetic (Amide — S-Enantiomer)

Pathways