Indications
Levobupivacaine Hydrochloride is a long-acting local anaesthetic. It is used to numb part of the body for surgery and procedures, for example spinal or epidural anaesthesia, nerve blocks, and local infiltration around a wound. It is also used for pain relief during labour and after operations, often as a continuous epidural infusion.
How It Works
It blocks sodium channels in nerve cells, which stops nerves from sending pain signals to the brain. The area supplied by those nerves becomes numb for several hours. It is the left-handed form of Bupivacaine and is thought to have a somewhat lower risk of heart and nerve toxicity.
Dosage and Administration
It is given only by an anaesthetist or trained doctor in a hospital or clinic, by injection or infusion, with monitoring equipment and resuscitation facilities available. The strength, volume and route are chosen by the doctor according to the procedure, the patient’s age, weight and health, so the dose is always as prescribed. It must never be injected directly into a vein.
Interactions
- Other local anaesthetics and some heart rhythm medicines (such as Lidocaine or Mexiletine) can add to its toxic effects.
- Medicines that slow its breakdown in the liver, such as Ketoconazole or Fluvoxamine, may raise its levels.
- Blood thinners (such as Warfarin, Heparin or Clopidogrel) increase the risk of bleeding with spinal or epidural injections; tell the doctor about them.
Contraindications
- Allergy to Levobupivacaine or other amide local anaesthetics (such as Lidocaine or Bupivacaine).
- Intravenous regional anaesthesia (Bier’s block) and paracervical block in labour.
- Severe low blood pressure or shock (for spinal or epidural use).
- Infection at the injection site or bleeding disorders (for spinal or epidural use).
Side Effects
Common effects include low blood pressure, nausea, vomiting, dizziness, headache, back pain at the injection site, fever and itching. After spinal or epidural use, temporary weakness or numbness of the legs and difficulty passing urine can occur. In labour, it may affect the baby’s heart rate, which is monitored.
Tell the staff at once, or get urgent medical help if already discharged, if you notice numbness around the mouth, metallic taste, ringing in the ears, blurred vision, confusion, muscle twitching, fits, chest pain, a slow or irregular heartbeat, difficulty breathing, or numbness or weakness that does not wear off.
Pregnancy and Lactation
It is commonly used for pain relief in labour and for caesarean section under medical supervision. Only small amounts pass into breast milk, and breastfeeding can usually continue after use.
Precautions and Warnings
- Used with care in liver disease, heart disease, heart block, older or frail patients, and low blood volume.
- Do not drive or use machinery until full feeling and strength have returned.
- Take care not to injure a numb area, for example with heat or pressure.
Overdose
High blood levels can cause numbness of the lips and tongue, dizziness, fits, loss of consciousness, very low blood pressure and dangerous heart rhythm problems. Hospital staff treat this immediately with oxygen, seizure control and lipid emulsion therapy.
Therapeutic Class
Local anaesthetic (amide type).
Storage
Store below 30°C, protected from light, as directed on the pack. Do not freeze. For hospital use; keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.