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Long-Acting Local Anaesthetic (Amide) Pregnancy: Used in epidural analgesia in labour; consider benefit-risk

Levobupivacaine

Brand names: Chirocaine

Adult dose

Dose: Epidural: 10-20 mL of 0.125-0.5%. Nerve block: 0.25-0.75%, up to max dose. Intrathecal: 1.5-3.5 mL of 0.5%
Route: Epidural / Intrathecal / Peripheral nerve block / Local infiltration
Frequency: Single injection or continuous infusion
Max: 2.5 mg/kg (plain); up to 3.75 mg/kg (with adrenaline)
Pure S-enantiomer of bupivacaine — less cardiotoxic than racemic bupivacaine. Potency similar to bupivacaine. Can be used intrathecally unlike ropivacaine

Paediatric dose

Dose: 1.25-2.5 mg/kg (caudal/epidural) mg/kg
Route: Epidural / Caudal
Frequency: Single or continuous
Max: 2.5 mg/kg
Seek specialist paediatric anaesthesia input

Dose adjustments

Renal

No adjustment for single doses

Hepatic

Caution with prolonged infusions in hepatic impairment

Paediatric weight-based calculator

Seek specialist paediatric anaesthesia input

Clinical pearls

  • S-enantiomer of bupivacaine: binds cardiac Na+ channels with lower affinity than racemic bupivacaine — significantly lower cardiotoxicity with equivalent analgesic potency
  • Unlike ropivacaine, levobupivacaine can be used intrathecally (spinal) — gives more flexibility than ropivacaine which is not licensed for spinal use
  • LAST treatment: 20% intralipid — 1.5 mL/kg bolus, 0.25 mL/kg/min infusion; lipid rescue equally applicable to all amide local anaesthetics
  • Interchangeable with bupivacaine in most regional anaesthetic techniques at equal volumes and concentrations
  • Preferred over racemic bupivacaine in some centres for its improved safety profile during prolonged epidural infusions

Contraindications

  • IV administration (unless LAST treatment)
  • Inflamed or infected injection site

Side effects

  • LAST (less cardiotoxic than bupivacaine)
  • Hypotension (sympathetic block)
  • Urinary retention
  • Motor block

Interactions

  • Other local anaesthetics (additive toxicity)
  • Adrenaline (extends duration)

Monitoring

  • Cardiovascular monitoring
  • Block level
  • Signs of LAST

Reference: BNFc; BNF 90; Chirocaine SPC; AAGBI LAST Guidelines 2023. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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