Levobupivacaine Kabi

Levobupivacaine

Surgical anaesth & pain management in adults & adolescents ≥12 yr. Analgesia in childn <12 yr.

Repeat aspiration before & during administration of a bolus dose (inj slowly & in incremental doses) at a rate of 7.5-30 mg/min, while closely observing the patient's vital functions & maintaining verbal contact. Immediately stop inj if toxic symptoms occur. Reduce dose & preferable to use lower conc (eg, 1.25 mg/mL) if combined w/ other agents (eg, opioids) in pain management. Max recommended single dose: 150 mg. Max recommended dose during 24-hr period: 400 mg. Adult Surgical anaesth as epidural slow bolus for surgery 10-20 mL (50-150 mg) spread over 5 min at conc of 5-7.5 mg/mL for moderate to complete motor block. Surgical anaesth in local infiltration 1-60 mL (2.5-150 mg max) at conc of 2.5 mg/mL. Adult & adolescent ≥12 yr Surgical anaesth as epidural slow inj for caesarean section 15-30 mL (75-150 mg) given over 15-20 min at conc of 5 mg/mL for moderate to complete motor block. Intrathecal surgical anaesth 3 mL (15 mg) at conc of 5 mg/mL for moderate to complete motor block. Perineural surgical anaesth (peripheral nerve block) 1-40 mL (2.5-150 mg max) at conc of 2.5-5 mg/mL for moderate to complete motor block. Ophth surgical anaesth (peribulbar block) 5-15 mL (37.5-112.5 mg) at conc of 7.5 mg/mL for moderate to complete motor block. Pain management as epidural bolus for labour analgesia 6-10 mL (15-25 mg) at conc of 2.5 mg/mL for minimal to moderate motor block. Min recommended interval between intermittent inj: 15 min. Pain management as epidural infusion for labour analgesia 4-10 mL/hr (5-12.5 mg/hr) at conc of 1.25 mg/mL for minimal to moderate motor block. Post-op pain management 10-15 mL/hr (12.5-18.75 mg/hr) at conc of 1.25 mg/mL or 5-7.5 mL/hr (12.5-18.75 mg/hr) at conc of 2.5 mg/mL for minimal to moderate motor block. Childn <12 yr Perineural analgesia (ilioinguinal/iliohypogastric blocks) 0.5 mL/kg/side (1.25 mg/kg/side) at conc of 2.5 mg/mL or 0.25 mL/kg/side (1.25 mg/kg/side) at conc of 5 mg/mL.

Hypersensitivity to levobupivacaine or other amide-type local anaesth. IV regional anaesth (Bier's block). Patients w/ severe hypotension eg, cardiogenic or hypovolaemic shock. Paracervical block in obstet. Take into account general contraindications related to regional anaesth, regardless of local anaesth used.

Can cause acute allergic reactions, CV effects & neurological damage. Use w/ caution for regional anaesth in patients w/ impaired CV function eg, serious cardiac arrhythmias. CNS introduction via intrathecal or epidural administration in patients w/ preexisting CNS diseases may potentially exacerbate some of these disease states. Perform blood or CSF aspiration prior to inj of original dose & all subsequent doses to avoid intravascular or intrathecal inj. -ve aspiration does not ensure against intravascular or intrathecal inj. During administration of epidural anaesth, it is recommended that a test dose be administered initially & the effects monitored before the full dose is given. Epidural anaesth may cause hypotension & bradycardia. Post-marketing reports of cauda equina syndrome & events indicative of neurotoxicity temporally associated w/ levobupivacaine use for ≥24 hr for epidural analgesia. Run IV fluids via an indwelling catheter to assure a functioning IV pathway. Use lowest dosage that results in effective anaesth to avoid high plasma levels & serious adverse effects. Avoid rapid inj of large vol & use fractional (incremental) doses when feasible. Small doses of local anaesth inj into the head & neck area, including retrobulbar, dental & stellate ganglion blocks, may produce adverse reactions similar to systemic toxicity seen w/ unintentional intravascular inj of larger doses. Clinicians who perform retrobulbar blocks should be aware that there have been reports of resp arrest following local anaesth inj. Post-marketing reports of chondrolysis in patients receiving post-op IA continuous infusion of local anaesth. IA continuous infusion is not an approved indication. Major influence on the ability to drive or use machines. Use w/ caution in patients receiving other local anaesth or agents structurally related to amide-type local anaesth; patients w/ liver disease or w/ reduced liver blood flow eg, alcoholics or cirrhotics; debilitated, elderly or acutely ill patients. Pregnancy. No data available in paed population <6 mth of age for ilioinguinal/iliohypogastric blocks.

Anaemia; hypotension; nausea. Dizziness, headache; vomiting; back pain; foetal distress syndrome; pyrexia; procedural pain.

Metabolism may be affected by CYP3A4 (eg, ketoconazole) & CYP1A2 (eg, methylxanthines) inhibitors. Toxic effects of anti-arrhythmic agents w/ local anaesth activity (eg, mexiletine) or class III anti-arrhythmic agents may be additive.

Anaesthetics - Local & General

N01BB10 - levobupivacaine ; Belongs to the class of amides. Used as local anesthetics.

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