In recent years
levobupivacaine, the pure S (-)-enantiomer of
bupivacaine, emerged as a safer alternative for
regional anesthesia than its racemic parent. It demonstrated less affinity and strength of depressant effects onto myocardial and central nervous vital centers in pharmacodynamic studies, and a superior pharmacokinetic profile. Clinically,
levobupivacaine is well tolerated in a variety of
regional anesthesia techniques both after bolus administration and continuous postoperative infusion. Reports of toxicity with
levobupivacaine are scarce and occasional toxic symptoms are usually reversible with minimal treatment with no fatal outcome. Yet,
levobupivacaine has not entirely replaced
bupivacaine in clinical practice. In
anesthesia and analgesia practice,
levobupivacaine and
bupivacaine produce comparable surgical sensory block with similar adverse side effects, and equal
labor pain control with comparable maternal and fetal outcome. The equipotency of the two drugs has been recently questioned, prompting clinicians to increase the dose of
levobupivacaine in an attempt to ensure adequate
anesthesia and analgesia and offsetting, therefore, the advantages of less motor block with
levobupivacaine. In this review we aim to discuss the pharmacological essentials of the safer profile of
levobupivacaine, and analyze the evidence regarding the current clinical indications.