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Abdomen
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Drug and dosageAdults – 10 ml on each side of 0.25% levobupivacaine (max. dose 2–3 mg/kg)Paediatrics – 0.1–0.8 ml/kg of 0.25% levobupivacaineContinuous infusion can be used at the rate of 10–15 ml/hr of 0.125–0.25% levobupivacaine
Local Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Elena González Burgos, Luis Luis García-García, M. Pilar Gómez-Serranillos, Francisca Gómez Oliver
Levobupivacaine (Fig. 15.8) is the S(-)-enantiomer of bupivacaine. Comparing to bupivacaine, levobupivacaine has similar potency, greater duration of action in neural tissue (10–15%) and less cardiac toxicity and central nervous toxicity (30% fewer toxic). This long-acting local anesthetic is used for major and minor surgical anesthesia (i.e., spinal anesthesia, epidural anesthesia) and, for analgesia (i.e., labor analgesia and postsurgical pain). Levobupivacaine is highly bound to plasma proteins (97%). It is metabolized in the liver through CYP3A4 and CYP1A2 isoforms CYP450 enzymes to the inactive metabolites 3-hydroxy levobupivacaine and desbutyl levobupivacaine. Levobupivacaine is mainly excreted as its metabolites in urine (mostly) and feces (Burlacu and Buggy, 2008; Foster and Markham, 2000; Leone et al., 2008; Sanford and Keating, 2010). Taking into account that this LA is metabolized via cytochrome P450 isoforms, its metabolism may be attenuated by the concomitant administration of CYP3A4 inhibitors such as ketoconazole and CYP142 inhibitors such as methylxanthines, increasing the plasma concentrations of levobupivacaine (AEMPS).
Acute pain management in children
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
Bupivacaine is still the most widely used LA in the epidural space, both for “single shot” and infusion techniques, although it is gradually being replaced by the newer levobupivacaine or ropivacaine.71 Concentrations in the range 2.5–0.625 mg/mL are the most suitable for children; dilute solutions of 1.25–0.625 are most commonly used for infusions. In clinical practice, differences between racemic bupivacaine, levobupivacaine, and ropivacaine are small, but levobupivacaine and ropivacaine may be a little less cardio- and neurotoxic and cause less unwanted motor blockade at equianalgesic doses.254[II], 139 The pharmacokinetics of epidural bupivacaine, ropivacaine, and levobupivacaine have been studied in children. Infusion of bupivacaine up to 0.4 mg/kg/h for several days in infants and children less than six months of age does not achieve toxic plasma concentrations, but the recommended dose is reduced to 0.2 mg/kg/h in neonates because of lower clearance and less plasma binding which may increase susceptibility to toxicity.71 Ropivacaine shows different infusion pharmacokinetics in that, unlike bupivacaine, accumulation was not observed over a study period of 72 hours in the neonate, although plasma levels were greater than in older children.139, 152 Levobupivacaine kinetics have been less investigated, but a 24-hour study of infusion of 1.25 or 0.625 mg/mL solutions in infants and children older than six months showed increasing plasma levels throughout the study period, although remaining well below accepted thresholds for toxicity.255
Effect of bilateral ultrasound-guided erector spinae blocks on postoperative pain and opioid use after lumbar spine surgery: A prospective randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2021
Amr Samir Wahdan, Tarek Ahmed Radwan, Mostafa Mahmoud Mohammed, Ahmed Abdalla Mohamed, Atef Kamel Salama
A low-frequency curved array ultrasound probe (Siemens ACUSON X300 Ultrasound System with curved probe) was placed in a transverse location at the operating level to visualise the tip of the transverse process, which was then centred on the ultrasonography device screen. The probe was then turned longitudinally 2–3 cm lateral to vertebral column, where the skin, subcutaneous tissue and erector spinae muscle could be seen over the acoustic shadows of the transverse processes. After proper sterilisation of the skin, an 18-G Tuohy needle was inserted parallel to the ultrasound beam in a cranial-to-caudal direction until it reached the transverse process. Confirmation of the proper location for the needle tip was achieved by injecting 0.5–1-mL saline, followed by lifting the erector spinae muscle off the transverse process without muscle distension. Afterward, either 20 mL of 0.25% levobupivacaine was injected for each of the patients in the ESPB group or 20 mL normal saline was used for each of the patients in the control group. All previous steps were then repeated on the contralateral side.
Comparison of the pharmacological properties of 0.375% bupivacaine with epinephrine, 0.5% ropivacaine and a mixture of bupivacaine with epinephrine and lignocaine – a randomized prospective study
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Piotr Bobik, Juliusz Kosel, Paulina Świrydo, Marcin Tałałaj, Igor Czaban, Wojciech Radziwon
In our study the measured parameters of brachial plexus block (delay of sensory and motor blockade, duration of motor and sensory blockade) using 0.375% bupivacaine with epinephrine and 0.5% ropivacaine did not differ between the two groups. Similar results were achieved by Watanabe et al. who in their study did not notice differences in time from the end of the procedure until the administration of rescue painkillers and during the duration of the motor blockade of the operated limb. Researchers found that ropivacaine and levobupivacaine (used in equal concentrations of 0.375%) provided the same level of postoperative analgesia [13]. In the study of Mageswaran et al. brachial plexus blockade with 0.5% levobupivacaine resulted in a significantly faster sensory and motor block compared to 0.5% ropivacaine, with comparable postoperative analgesia 6 h after performing the block [14]. Piangatelli et al. however claimed that ropivacaine induces faster onset of motor block than levobupivacaine with shorter analgesic effect. In this study, however, the difference between the concentrations of local anesthetics was 0.25% (0.75% ropivacaine vs. 0.5% levobupivacaine) [15]. With similar pharmacologic properties and the lack of inevitable advantages of any of the drugs in clinical trials, the safety profile may support the choice of ropivacaine for volume blocks in regional anesthesia.
Comparison of Effects of Levobupivacaine and Ropivacaine Infiltration on Cutaneous Wound Healing in a Rat Model
Published in Journal of Investigative Surgery, 2018
Cihangir Biçer, Yalcin Yontar, Günhan Gökahmetoğlu, Teoman Eskitaşçıoğlu
In contrast to ropivacaine, several studies have been carried out to determine the potential adverse effects of levobupivacaine on cutaneous wound healing; however, there have been conflicting results. In an experimental study, Dere et al. [8] investigated the effects of different doses of levobupivacaine (1.25 mg/ml, 2.50 mg/ml, and 3.75 mg/ml) in a rat wound model. The tensile strength was found to be higher in all levobupivacaine groups compared with controls at day 8, and the highest value was observed in the group that was administered levobupivacaine at the highest dose of 3.75 mg/ml. Furthermore, the hydroxyproline concentration and fibroblastic activity of all levobupivacaine groups were found to be higher when compared to the controls. The authors concluded that levobupivacaine has a positive effect on wound healing at clinical doses, and this effect increased with increasing dosages. However, in our opinion, definitive conclusions on the clinical influence of levobupivacaine cannot be accurately drawn due to the short duration of their study. An increase in wound tensile strength corresponds to an increase in the number of fibroblasts, which begin to produce immature collagen during the proliferative phase of wound healing [20].Thus, the cross-linking of new collagen fibers does not actually begin until 5–8 days after wound formation [21]. Based on these facts, measuring the wound tensile strength at later periods of the proliferative phase, as performed in our study, would lead to results that can be more accurately translated to clinical conditions.