lPREGNANCYLarge doses during delivery can cause
neonatal respiratory depression, hypotonia, and
bradycardia after epidural block. Avoid if possible in the
first trimester—toxicity inanimalstudies. May cause fetal
distress syndrome. Do not use for paracervical block in
obstetrics. Do not use 7. 5 mg/mL strength in obstetrics.
lBREAST FEEDINGAmount too small to be harmful.
lHEPATIC IMPAIRMENTUse with caution.
lDIRECTIONS FOR ADMINISTRATIONFor 1. 25 mg/mL
concentration dilute standard solutions with sodium
chloride 0. 9 %.
lPRESCRIBING AND DISPENSING INFORMATION
Levobupivacaine is an isomer of bupivacaine.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Chirocaine(AbbVie Ltd)
Levobupivacaine (as Levobupivacaine hydrochloride) 2.5 mg per
1mlChirocaine 25 mg/ 10 ml solution for injection ampoules|
10 ampouleP£ 14. 11 (Hospital only)
Levobupivacaine (as Levobupivacaine hydrochloride) 5 mg per
1mlChirocaine 50 mg/ 10 ml solution for injection ampoules|
10 ampouleP£ 16. 15 (Hospital only)
Levobupivacaine (as Levobupivacaine hydrochloride) 7.5 mg per
1mlChirocaine 75 mg/ 10 ml solution for injection ampoules|
10 ampouleP£ 24. 23 (Hospital only)
Infusion
▶Chirocaine(AbbVie Ltd)
Levobupivacaine (as Levobupivacaine hydrochloride) 1.25 mg per
1mlChirocaine 125 mg/ 100 ml infusion bags| 24 bagP£ 174. 22
Chirocaine 250 mg/ 200 ml infusion bags| 12 bagPsLidocaine hydrochloride
(Lignocaine hydrochloride)
lINDICATIONS AND DOSE
Infiltration anaesthesia
▶BY LOCAL INFILTRATION
▶Neonate:Up to 3 mg/kg, dose to be given according to
patient’s weight and nature of procedure, dose may be
repeated not more often than every 4 hours, 3 mg/kg
equivalent to 0. 3 mL/kg of 1 % solution.▶Child 1 month–11 years:Up to 3 mg/kg, dose to be given
according to patient’s weight and nature of procedure,
dose may be repeated not more often than every
4 hours, 3 mg/kg equivalent to 0. 3 mL/kg of 1 % solution
▶Child 12–17 years:(max. per dose 200 mg), dose to be
given according to child’s weight and nature of
procedure, dose may be repeated not more often than
every 4 hours
DOSESATEXTREMESOFBODY-WEIGHT
▶When used by local infiltrationTo avoid excessive dosage in
obese patients, weight-based doses for non-emergency
indications may need to be calculated on the basis of
ideal body-weight.
Intravenous regional anaesthesia and nerve block
▶BY REGIONAL ADMINISTRATION
▶Child:Seek expert advice
Dental anaesthesia
▶BY REGIONAL ADMINISTRATION
▶Child:Seek expert advice
Pain relief (in anal fissures, haemorrhoids, pruritus ani,
pruritus vulvae, herpes zoster, or herpes labialis)|
Lubricant in cystoscopy|Lubricant in proctoscopy
▶TO THE SKIN USING OINTMENT
▶Child:Apply 1 – 2 mL as required, avoid long-term useLMX 4®
Anaesthesia before venous cannulation or venepuncture
▶TO THE SKIN
▶Child 1–2 months:Apply up to 1 g, apply thick layer to
small area ( 2. 5 cm 62. 5 cm) of non-irritated skin at
least 30 minutes before procedure; may be applied
under an occlusive dressing; max. application time
60 minutes, remove cream with gauze and perform
procedure after approximately 5 minutes
▶Child 3–11 months:Apply up to 1 g, apply thick layer to
small area ( 2. 5 cm 62. 5 cm) of non-irritated skin at
least 30 minutes before procedure; may be applied
under an occlusive dressing; max. application time
4 hours, remove cream with gauze and perform
procedure after approximately 5 minutes
▶Child 1–17 years:Apply 1 – 2. 5 g, apply thick layer to
small area ( 2. 5 cm 62. 5 cm) of non-irritated skin at
least 30 minutes before procedure; may be applied
under an occlusive dressing; max. application time
5 hours, remove cream with gauze and perform
procedure after approximately 5 minutesIMPORTANT SAFETY INFORMATION
▶When used by local infiltration
The licensed doses stated may not be appropriate in
some settings and expert advice should be sought.
Should only be administered by, or under the direct
supervision of, personnel experienced in their use, with
adequate training in anaesthesia and airway
management, and should not be administered
parenterally unless adequate resuscitation equipment is
available.lCONTRA-INDICATIONS
▶When used by regional administrationApplication to the
middle ear (can cause ototoxicity).avoid injection into
infected tissues.avoid injection into inflamed tissues.
preparations containing preservatives should not be used
for caudal, epidural, or spinal block, or for intravenous
regional anaesthesia (Bier’s block).should not be applied
to damaged skin
CONTRA-INDICATIONS, FURTHER INFORMATION
▶When used by regional administrationLocal anaesthetics
should not be injected into inflamed or infected tissues nor
should they be applied to damaged skin. Increased
absorption into the blood increases the possibility of
systemic side-effects, and the local anaesthetic effect may
also be reduced by altered local pH.
lCAUTIONS
▶When used by regional administrationChildren (consider dose
reduction).debilitated patients (consider dose reduction).
epilepsy.hypovolaemia.impaired cardiac conduction.
impaired respiratory function.myasthenia gravis.shock
lINTERACTIONS→Appendix 1 : antiarrhythmics
lSIDE-EFFECTSAnxiety.arrhythmias.atrioventricular
block.cardiac arrest.circulatory collapse.confusion.
dizziness.drowsiness.euphoric mood.headache.
hypotension (may lead to cardiac arrest).loss of
consciousness.methaemoglobinaemia.muscle twitching.
myocardial contractility decreased.nausea.neurological
effects.nystagmus.pain.psychosis.respiratory disorders
.seizure.sensation abnormal.temperature sensation
altered.tinnitus.tremor.vision blurred.vomiting
SIDE-EFFECTS, FURTHER INFORMATION
Toxic effectsThe systemic toxicity of local anaesthetics
mainly involves the central nervous and cardiovascular
systems.
MethaemoglobinaemiaMethylthioninium chloride can
be used for the treatment of drug-induced
methaemoglobinaemia.826 Local anaesthesia BNFC 2018 – 2019
Anaesthesia15