Efficacy of Levobupivacaine in Regional Anaesthesia - A Narrative Review

Abstract

Background: The pursuit of safer and more effective anesthetic agents continues to be a key focus in anesthesiology. Levobupivacaine, a purified derivative of bupivacaine, has emerged as a preferable alternative for regional anesthesia due to its enhanced safety profile. Clinical studies have shown that levobupivacaine provides similar efficacy to bupivacaine but with a more favorable pharmacokinetic profile. It has been well-tolerated in various regional anesthesia techniques, including bolus administration and continuous postoperative infusion, with few adverse drug reactions, typically linked to incorrect administration or pharmacological effects. Allergic reactions are rare. Comparative studies indicate that levobupivacaine and bupivacaine offer comparable surgical sensory blocks, adverse effects, and labour analgesia outcomes, with similar safety profiles for both maternal and fetal health. Objectives: This review aims to examine the pharmacokinetic and pharmacological benefits of levobupivacaine, highlighting its safety and clinical applications based on current evidence. Results: Levobupivacaine is generally more powerful than ropivacaine but less strong than bupivacaine, according to the majority of clinical investigations. A total of 60 studies were discovered. Some studies, such as those with unavailable full-text publications, were eliminated. Finally, 26 publications were chosen and studied since they were relevant to the current review aims. Sushma examined, in 60 patients receiving axillary block utilizing the nerve stimulation technique, the effects of 30 ml of 1.5% lidocaine with adrenaline compared to 30 ml of 0.333% levobupivacaine. Agarwal compared the effectiveness of bupivacaine and levobupivacaine in 56 patients receiving supraclavicular brachial plexus block. Levobupivacaine, according to the study, caused both motor and sensory blocks to start more quickly. Conclusion: Levobupivacaine is a long-acting local anesthetic that closely resembles bupivacaine in its clinical effects, but it offers specific advantages such as reduced cardiotoxicity.