Levobupivacaine


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : Inj Surgical anesth Epidural block: 50-100 mg (using 0.5% soln) or 75-150 mg (using 0.75% soln). Caesarean section: 75-150 mg (using 0.5% soln). Spinal block: 15 mg (using 0.5% soln). Max: 150 mg/dose; 400 mg/day. Peripheral nerve block 2.5-150 mg or 1-2 mg/kg (0.4 mL/kg) of a 0.25 or 0.5% soln. Not to exceed 40 mL. Max: 150 mg/dose; 400 mg/day. Infiltration anesth Up to 150 mg (using 0.25% soln). For peribulbar block in ophth procedures: 37.5-112.5 mg (using 0.75% soln). Max: 150 mg/dose; 400 mg/day. Acute pain Pain relief during labour: 15-50 mg (using 0.25% soln), given as a bolus dose. Post-op pain: 10-25 mg/hr (using 0.25% soln), given as an epidural infusion. Max: 150 mg/dose; 400 mg/day.
Dosage Details
Injection
Acute pain
Adult: Pain relief during labour: 15-50 mg (6-20 ml) of a 0.25% solution, to be given as a bolus dose; alternatively, dose may be given via continuous infusion at 5-12.5 mg (4-10 ml) per hr using 0.125% solution or 5-12.5 mg (8-20 ml) per hr using 0.0625% solution. Postoperative pain: 10-25 mg (4-10 ml) per hr of a 0.25% solution, 12.5-18.75 mg (10-15 ml) per hr of a 0.125% solution or 12.5-18.75 mg (20-30 ml) per hr of a 0.0625% solution; dose may be given as an epidural infusion. Max: 150 mg/dose; 400 mg/day.

Injection
Peripheral nerve block
Adult: 2.5-150 mg or 1-2 mg/kg (0.4 ml/kg) of a 0.25 or 0.5% solution. Not to exceed 40 ml. Max: 150 mg/dose; 400 mg/day.

Injection
Surgical anaesthesia
Adult: Epidural block: 50-100 mg (10-20 ml) of a 0.5% solution or 75-150 mg (10-20 ml) of a 0.75% solution. Caesarean section: 75-150 mg (15-30 ml) of a 0.5% solution. Spinal block: 15 mg (3 ml) of a 0.5% solution. Max: 150 mg/dose; 400 mg/day.

Injection
Infiltration anaesthesia
Adult: Up to 150 mg (60 ml) of a 0.25% solution. For peribulbar block in ophth procedures: 37.5-112.5 mg (5-15 ml) of a 0.75% solution. Max: 150 mg/dose; 400 mg/day.
Child: For ilioinguinal or iliohypogastric blocks in children <12 yr: 0.625-2.5 mg/kg (0.25-0.5 ml/kg) of a 0.25 or 0.5% solution.
Reconstitution
When needed, dilutions should be made with normal saline.
Contraindications
Not to be used in IV regional anesth (Bier's block) and paracervical block in obstetrics. Do not use 0.75% solution for epidural block in obstetrics. Hypovolaemia, complete heart block.
Special Precautions
Epilepsy, respiratory impairment, impaired cardiac conduction, bradycardia, severe shock, acute porphyria, myasthenia gravis, renal or hepatic impairment. Pregnancy, lactation. Reduce dose in elderly or debilitated patients. Resuscitative equipment should be available. Do not use solutions containing adrenaline for anesth in appendages. Do not use solutions containing preservatives for caudal or epidural block.
Adverse Reactions
CNS effects such as restlessness, anxiety, dizziness, confusion, respiratory depression and convulsions. Neuromuscular and skeletal weakness, blurred vision, pupillary constriction, tinnitus. Hypotension, bradycardia and CV collapse which may lead to cardiac arrest. Rarely, hypersensitivity reactions.
Drug Interactions
Plasma levels may be reduced when used with enzyme-inducing drugs such as rifampicin. Substrates for or inhibitors of CYP3A4 and CYP1A2 may affect the plasma levels of levobupivacaine.
Action
Description: Levobupivacaine is a long acting local anaesthetic of the amide type. It is the S-enantiomer of bupivacaine. It blocks nerve conduction in sensory and motor nerves mainly by interacting with voltage sensitive sodium channels on the cell membrane. It also interferes with impulse transmission and conduction in other tissues. Levobupivacaine is given as the hydrochloride for infiltration anaesthesia and regional nerve blocks including epidural block. It is contraindicated in obstetric paracervical block and IV regional anaesthesia (Bier's block). The 0.75% solution is also contraindicated for epidural blocks in obstetrics.
Pharmacokinetics:
Distribution: Protein binding: At least 97%. Volume of distribution after IV admin: 67 litres.
Metabolism: Extensively metabolised in liver. Major metabolite: 3-Hydroxylevobupivacaine.
Excretion: Mean half-life after IV admin: About 80 min. Excreted as its metabolites largely in the urine, with some in faeces.
Storage
To be used immediately after opening. After dilution in normal saline: Chemical and physical in-use stability at 20-22°C for 7 days.
Disclaimer: This information is independently developed by MIMS based on Levobupivacaine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in