A long-acting local anaesthetic
Levobupivacaine
A long-acting local anaesthetic for epidurals, spinals and nerve blocks, developed to be gentler on the heart than bupivacaine.
What is Levobupivacaine?
Levobupivacaine is a long-acting local anaesthetic closely related to bupivacaine, used for epidurals, spinal anaesthetics and nerve blocks. It gives long-lasting numbness for surgery and pain relief and is given only by trained anaesthetists who limit the amount used. It was developed as a refined version of bupivacaine that is less harmful to the heart if too much reaches the bloodstream, though the same care over placement and amount still applies. As with all local anaesthetics, the main serious risk is local anaesthetic systemic toxicity if too much enters the circulation.
Education and reference only. This is a plain-language guide to Levobupivacaine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Levobupivacaine is a long-acting local anaesthetic and a close relative of bupivacaine. It is used by anaesthetists for epidurals (numbing the lower body, often in labour or after surgery), spinal anaesthetics (for operations such as caesarean sections), and nerve blocks for and after surgery. It was developed as the single mirror-image form of bupivacaine, chosen because it tends to be less harmful to the heart. It is given by injection by hospital specialists.
How it works
Levobupivacaine blocks the electrical signals nerves use to carry pain, so the area it reaches becomes numb for a long time, which suits longer operations and ongoing pain relief. It is one of the two mirror-image forms that make up ordinary bupivacaine, and was selected because this form is gentler on the heart while still giving strong, lasting numbness. As with all local anaesthetics, its safety depends on the anaesthetist limiting how much reaches the rest of the body.
Company & origin
Originated / developed by: Generic (long-established).
A long-acting local anaesthetic used in the UK for epidurals, spinal anaesthesia and nerve blocks, developed as a less heart-toxic relative of bupivacaine.
Practical use
How to take Levobupivacaine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Levobupivacaine is given by an anaesthetist as an injection into the back (epidural or spinal) or around nerves (a nerve block), in hospital.
- For an epidural, a fine tube may be left in place so pain relief can be topped up during labour or after surgery.
- The team checks the needle or tube position carefully before giving it, to avoid the medicine entering a vein.
- Your blood pressure, heart rate and breathing are monitored while it works and afterwards.
- Expect the lower body or limb to feel numb and heavy for some time; staff will help you move safely until feeling returns.
- Tell the team about heart problems, other medicines and any past reaction to a local anaesthetic before treatment.
Weighing it up
Advantages & disadvantages of Levobupivacaine
Advantages
- Long-lasting numbness for longer operations and for pain relief during labour and after surgery.
- Developed to be less harmful to the heart than bupivacaine if some reaches the bloodstream.
- Allows major surgery to be done with a spinal or epidural, and pain relief to be topped up through a tube.
Disadvantages
- If too much reaches the bloodstream it can still cause local anaesthetic systemic toxicity, with fits or heart-rhythm problems.
- Epidurals and spinals can lower blood pressure and leave the lower body numb and heavy for a while.
- It is given only in hospital by specialists and is not suitable for everyone.
Practical use
Good to know
Levobupivacaine offers the long-lasting numbness of bupivacaine but was developed to be less cardiotoxic, meaning gentler on the heart if some accidentally reaches the bloodstream — but anaesthetists still check needle and tube placement carefully and limit the amount, because local anaesthetic systemic toxicity remains the key risk. Early warning signs of too much absorption include a numb mouth or metallic taste, ringing ears and dizziness, with fits or heart-rhythm problems in serious cases. After an epidural or spinal, the lower body can stay numb and heavy for a while, so movement is supported until feeling and strength return. Tell the team about heart problems and any previous reactions to local anaesthetics.
Who should not take it / use with caution
- People who have had a serious allergic reaction to levobupivacaine or similar local anaesthetics should not receive it.
- It is used cautiously in significant heart disease and severe liver problems, with the amount reduced.
- Spinals and epidurals are not suitable for everyone, such as those with certain bleeding problems, infections at the site or low blood pressure.
Monitoring
- Close monitoring of blood pressure, heart rate and breathing during and after the block.
- Watching for early signs of toxicity such as a metallic taste, ringing ears, dizziness or confusion.
- Checking that feeling and strength return normally, and managing any after-effects such as headache.
Side effects
- Numbness, heaviness and weakness in the treated area, which is expected and wears off.
- A drop in blood pressure after a spinal or epidural, which the team treats; sometimes headache after a spinal.
- If too much is absorbed: dizziness, ringing ears, fits and heart-rhythm problems needing urgent care.
Key interactions
- Other medicines affecting heart rhythm, or other local anaesthetics, can add to its effects, so the total amount is limited.
- Blood-thinning medicines affect whether an epidural or spinal can be done safely, because of bleeding risk around the spine.
- Some sedatives and general anaesthetics given alongside it can add to effects on blood pressure and breathing.
Available as: Injection given by an anaesthetist for epidural, spinal and nerve-block anaesthesia, sometimes through an indwelling tube.
Answers
Levobupivacaine: frequently asked questions
What is levobupivacaine used for?
It is a long-acting local anaesthetic used for epidurals, spinal anaesthetics and nerve blocks in surgery and childbirth, giving long-lasting numbness.
How is it different from bupivacaine?
It is a refined, single mirror-image form of bupivacaine, chosen because it tends to be less harmful to the heart while giving the same lasting numbness.
Is it safer for the heart?
It was developed to be less cardiotoxic than bupivacaine, but anaesthetists still limit the amount and check placement carefully, as toxicity remains the main risk.
Will I be awake during surgery?
With a spinal or epidural you can be awake but pain-free; your anaesthetist will discuss whether you also have sedation or a general anaesthetic.
How long does the numbness last?
It can last several hours; your lower body or limb may feel numb and heavy until it wears off, and staff will help you move safely.
The wider class
About Local anaesthetic (long-acting)
Levobupivacaine belongs to the local anaesthetic (long-acting) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
Browse by body system
Authoritative sources
- BNF
- NICE CKS
Building a medicines information resource?
We create evidence-led, dose-free drug and formulary references for teams.