Levobupivacaine

How it works

It reversibly blocks voltage-gated sodium channels in nerve membranes, preventing impulse initiation and conduction to produce local anaesthesia and sensory block.

Prescribing in practice

• Guard against systemic local-anaesthetic toxicity by aspirating before and during injection, using incremental dosing and adhering to maximum dose limits — have resuscitation facilities and lipid emulsion available, as inadvertent intravascular injection can cause seizures and cardiac arrest.
• Levobupivacaine has a better cardiac safety profile than racemic bupivacaine but is still cardiotoxic in overdose; it must never be given by intravenous bolus and is not for intravenous regional anaesthesia (Bier's block).
• Reduce dose in frail, elderly or hepatically impaired patients and avoid injection into infected or inflamed tissue.

Monitoring

Monitor cardiovascular and respiratory status and conscious level during and after administration, watching for early signs of systemic toxicity such as perioral tingling, tinnitus or agitation.

Counselling the patient

• Explain the area will feel numb and possibly heavy or weak for some hours and to protect the numb part from injury.
• Tell staff immediately about ringing in the ears, a metallic taste, dizziness or numbness around the mouth.

Evidence & guidelines

Levobupivacaine is a well-established regional anaesthetic with a favourable cardiotoxicity profile relative to bupivacaine; UK practice and the SPC mandate strict toxicity precautions and dose limits.