Local Anaesthetic (Amide — S-Enantiomer)
Pregnancy: Used for epidural analgesia in labour — preferred over racemic bupivacaine by many obstetric units
Levobupivacaine
Brand names: Chirocaine
Adult dose
Dose: Epidural: 0.125–0.25% 6–10 mL; Nerve block: 0.25–0.5%; Infiltration: 0.25% up to 150 mg
Route: Epidural / Peripheral nerve block / Infiltration
Frequency: Single dose or continuous epidural infusion
Max: 150 mg per dose
S-enantiomer of bupivacaine — similar clinical profile but lower cardiotoxicity and CNS toxicity. Preferred over racemic bupivacaine in many regional anaesthesia protocols. Not available as hyperbaric preparation — ropivacaine or heavy bupivacaine used for spinal.
Paediatric dose
Dose: 1–2 mg/kg
Route: Infiltration / Epidural
Frequency: Single dose
Max: 2 mg/kg
Under specialist guidance for paediatric regional anaesthesia.
Dose adjustments
Renal
No specific dose adjustment required.
Hepatic
Caution in severe hepatic impairment.
Paediatric weight-based calculator
Under specialist guidance for paediatric regional anaesthesia.
Clinical pearls
- Developed to reduce the cardiac toxicity of racemic bupivacaine — the R-enantiomer is responsible for most cardiotoxicity
- LAST antidote: Intralipid 20% as per bupivacaine entry
- Widely used for continuous epidural infusions in labour analgesia and post-operative pain
Contraindications
- IV administration
- IV regional anaesthesia
Side effects
- LAST (lower risk than racemic bupivacaine)
- Hypotension
- Bradycardia
- Postdural puncture headache (epidural)
Interactions
- Other local anaesthetics (additive)
- Antiarrhythmics (additive cardiotoxicity)
Monitoring
- Signs of LAST
- Haemodynamics
- Block level
Reference: BNFc; BNF 90; AAGBI LAST Guidelines 2023; OAA (Obstetric Anaesthetists Association) Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators