It is indicated for surgical anesthesia and postoperative pain management. Adults Levobupivacaine is indicated in adults for: Surgical Anaesthesia Major: Epidural (including for caesarean section),intrathecal,peripheral nerve block. Minor: Local infiltration,peribulbar block in ophthalmic surgery Pain Management For continuous epidural infusion,single or multiple bolus administration for postoperative,labour or chronic pain For continuous epidural analgesia,levobupivacaine may be administered in combination with epidural fentanyl,morphine or clonidine. Children Levobupivacaine is indicated in children for infiltration analgesia (ilioinguinal/ iliohypogastric blocks).
The dose of any local anaesthetic differs with the anaesthetic procedure,the area to be anaesthetised,the vascularity of the tissues,the number of neuronal segments to be blocked,and the intensity of the block,the degree of muscle relaxation required, the duration of the anaesthesia desired,individual tolerance,and the physical condition of the patient. The recommended dosage guidelines of Pivacain- L ? are given below: Only for the use of Medical Professional Dosage Recommendations % Concentrat ion Dose Surgical Anaesthesia Epidural for surgery 0.5-0.75 10 -20 ml (50-150 mg) solution over 5 minutes,maximum 375 mg Epidural for caesarean section 0.5 15 - 30 ml (75 - 150mg) solution over 15-20 minutes Peripheral Nerve block 0.25-0.5 1- 40 ml (maximum 150mg) Intrathecal 0.5 3 ml (15mg) Ophthalmic (Peribulbar block) 0.75 5 - 15 ml (37.5 - 112.5mg) Local Infiltration : Adults 0.25 1-60 ml (maximum 150mg) Local Infiltration : Children < 12 yrs 0.25 -0.5 0.25 - 0.50 ml/kg (1.25 - 2.5mg/kg) Pain Management 1 Labour analgesia (epidural bolus) 0.25 6-10 ml (15-25 mg),the minimum recommended interval between intermittent injections is 15 minutes Labour analgesia (epidural infusion) 0.125 4-10 ml/ hour (5-12.5 mg/h) Post-operative pain (epidural infusion) 0.125 10-15 ml/ hour (12.5 - 18.75 mg/hour),maximum 400 mg in 24 hours 0.25 5-7.5 ml/ hour (12.5 - 18.75 mg/hour),maximum 400 mg in 24 hours 1 In pain management levobupivacaine can be used epidurally with fentanyl,morphine or clonidine and repeated intermittent boluses may be used. The levobupivacaine dose should be reduced and use of a lower concentration (e.g. 1.25 mg/ml or 0.125%) is preferable.
Levobupivacaine are contraindicated in those with a known sensitivity to local anaesthetic amide agents. Levobupivacaine also should not be used for intravenous regional anaesthesia (e.g. Bier block). Levobupivacaine solutions are contraindicated for use in paracervical block in obstetrics.
Adverse reactions to levobupivacaine are characteristic to those seen with bupivacaine and other local anesthetics in the amide class. The most common side effects are hypotension,nausea,postoperative pain,fever,vomiting,anemia, pruritus,pain,headache,constipation,dizziness,and fetal distress. Other less come side effects are respiratory insufficiency,hypokinesia,involuntary muscle contraction,generalised spasm,tremor,syncope,decreased cardiac output,ECG changes indicative of heart block,bradycardia or ventricular tachyarrythmias that may lead to cardiac arrest
Levobupivacaine is pregnancy category B. There were no adequate and wellcontrolled studies in pregnant women of the effects of levobupivacaine on the developing foetus. Levobupivacaine should only be used during pregnancy if the benefits outweigh the risks. The excretion of levobupivacaine or its metabolites in human milk has not been established. Some local anaesthetic drugs are excreted in breast milk and caution should be exercised when levobupivacaine is administered to a nursing woman.
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