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Concept
Levobupivacaine
Summary
Levobupivacaine (rINN) is a local anaesthetic drug indicated for minor and major surgical anaesthesia and pain management. It is a long-acting amide-type local anaesthetic that blocks nerve impulses by inhibiting sodium ion influx into the nerve cells. Levobupivacaine is the S-enantiomer of racemic bupivacaine and therefore similar in pharmacological effects. The drug typically starts taking effect within 15 minutes and can last up to 16 hours depending on factors such as site of administration and dosage.
Levobupivacaine was designed, in the late 1970s, to be a safer and more effective alternative to bupivacaine, which had been associated with a higher risk of cardiotoxicity. Compared to bupivacaine, levobupivacaine is associated with less vasodilation and has a longer duration of action. It is approximately 13 per cent less potent (by molarity) than racemic bupivacaine and has a longer motor block onset time. Ropivacaine is, next to levobupivacaine, another less cardiotoxic alternative to bupivacaine.
Levobupivacaine hydrochloride is commonly marketed by AbbVie under the trade name Chirocaine. In Europe, Chirocaine is available – prescription only – in concentrations ranging from 0.625 mg/ml to 7.5 mg/mL.
Levobupivacaine, the S(-)-enantiomer of bupivacaine has been developed as an alternative to the racemic mixture, as it has been shown to have a lower cardiotoxicity than bupivacaine. Under European Union advice, it can be applied for minor and major surgical anaesthesia, as well as (post-operative) pain management. Particularly, it has been found suitable for multiple procedures, such as epidural block. It is effective for human patients who receive elective Caesarean section or lower body surgery, as it does not diverge dramatically in terms of sensory and/or motor block duration in comparison to bupivacaine. Deserving of consideration is the fact that its enhanced motor blocking can be a downside for patients receiving an epidural injection during childbirth, as a certain level of movement may still be required.
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