Levobupivacaine is the oure S(-)-enantiomer of racemic bupivaciane but is less toxic to the heart and central nervous system. Previous studies have shown that it is of equal potency with Bupivacaine in terms of onset of motor blockade, duration of sensor and motor blockade but a significant delay in the onset motor blackade (21 min versus 10 min). one study was done where aspirated CSF was used instead of adding sodium bicarbonate to adjust the pH-adjusted Levobupivacaine0.5% for spinal anesthesia. Thirty patients undergoing elective minor surgery received either 15mg of Levobupivacaine 0.5% isobaric or solution of 15mg of Levobupivacaine 0.5% isobaric with 1:1 mixture of aspirated CSF. Time of motor block onset and pH level were measured in both groups. Results showed faster motor block onset for pH-adjusted Levobupivacaine (1.87 +/- 0.65min versus 18.70 +/-3.26min) and pH level was also higher (7.12 +/-0.05 versus 6.04 +/-0.28). we conclude that the alkalinization by addition of CSF to Levobupivacaine 0.5% via 1:1 mixture speeds the onset motor block. Time to reach a Bromage score from 0 to 3 was shorter and pH level was more basic from the pH-adjusted Levobupivacaine, which may explain the faster onset since pH of the solution was closer to the pKa of Levobupivacaine.
Human ; LEVOBUPIVACAINE ; ANESTHETICS, LOCAL ;

BACKGROUND: Caudal epidural anesthesia is commonly performed in conjunction with general anesthesia. Bupivacaine and Levobupivacaine are used in epidural blockade that provide anesthesia and analgesia intraoperative and post-operatively.

OBJECTIVES: To compare the intraoperative and postoperative efficacy and safety of Bupivacaine and Levobupivacaine in children undergoing elective sub-umbilical operations under general and caudal anesthesia.

METHODS: Randomized control trial done in Philippine Children's Medical Center. Sixty-one subjects aged 6-months -8 years old, ASA I-II, undergoing subumbilical operations were randomly grouped to receive Bupivacaine and Levobupivacaine during anesthesia induction. Hemodynamic parameters, Bromage, and CHIPPS were recorded.

RESULTS: Results suggest both drugs have a significant effect in lowering heart rate and MAP. Bromage scores for patients from both groups are consistent at 0. The number of patients with a CHIPPS classification of 4-10, is significantly higher for bupivacaine group than levobupivacaine group.

CONCLUSION: Both Bupivacaine and Levobupivacaine provide adequate analgesia intraoperatively with no reports of intraoperative movement, increased inhalational agent concentration and additional intravenous analgesics. Post-operatively, no adverse effects and motor block was noted however Levobupivacaine has a longer efficacy as it required lesser rescue does post-operatively compared to Bupivacaine. 

Human ; Anesthesia, Caudal ; Bupivacaine ; Levobupivacaine ; Monitoring, Intraoperative

Single enantiomer compounds like levobupivacaine appear to be safe alternative to racemic agents, like bupivacaine for postoperative analgesia. This double-blind randomized dose ranging trial amed to compafe the efficacy sna safety of three concentration of continuous epidural infusion of levobupivacaine for postoperative analgesia after lower extremity orthopedic surgery. After informed consent, 63 eligible patients were randomized to receive levobupivacaine 0.0625%, 0.125%, or 0.25% as a continuous postoperative epidural infusion. Intraoperatively,vital signs, oxygenation, sensory block level, motor block, and abnormal signs and symptoms were monitored. on and a half (1 1/2) hours after the last intraoperative bolus of levobupivacaine, the epidural infusion was started at a rate of 6/ mL/h for 24 24 hours. Pain intensity and pain reliefscores, using the 10-cm visul analog scale, were assessed postoperatively. The time to first request for analgesia (with morphine or tramadol) and the total rescue doses gicen were recorded. Twenty patients were randomized to Goup A (0.0625%), 22 to Group B (0.125%), and 21 to Group C (0.25%). All three group were similar as to age, gender distribution and baseline physical findings. Pain scores, pain relief, and ie to the first rescue does were not significant different among the three groups. The most common adverse events were fever (8%), hypotensy (3%), and vomiting (2%). one patient developed severe hypotensio probably secondary to inadequately replaced intraoperative blood loss. Levobupivacaine is effective and safe for postoperative analgesia as an epidural infusion at 0.0625%, 0.125%, and 0.25%.
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; LEVOBUPIVACAINE ; ANALGESIA ; ORTHOPEDICS ; ANESTHETICS, LOCAL ;