Possible Interaction: Epinephrine and Levobupivacaine

“Conclusions: Intraperitoneal administration of levobupivacaine with epinephrine is associated with modest analgesia following laparoscopic cholecystectomy.”

“ Epinephrine … levobupivacaine absorption half-life {4.22 [95 % confidence interval (CI) 2.53–6.50] vs. 7.02 [95 % CI 3.74–14.1]; p < 0.… support the addition of epinephrine to the local anaesthetic solution, especially when doses of levobupivacaine of >1.5 mg kg−1 are required.”

“ Levo-bupivacaine also attenuated the postoperative stress response as indicated by significant reduction plasma epinephrine levels.”

“Both patients were treated preoperatively with β-adrenergic antagonist medications, which may have masked the cardiovascular signs of the unintentional intravascular administration of levobupivacaine with epinephrine.”

“Immediately after the administration of levobupivacaine 0.5% with epinephrine 2.5 μg/mL, the patients developed grand mal seizures, despite negative aspiration for blood and no clinical signs of intravenous epinephrine administration.”

“CONCLUSION The addition of 5-μg/mL ep nephrine to a single bolus thoracic paravertebral injection of 1-mg/kg lev obupivacaine si gnificantly decreased Cmax and delayed Tmax of levobupivacaine.”

“The addition of epinephrine to levobupivacaine may be a useful strategy to reduce systemic levobupivacaine toxicity.”

“CONCLUSION After arthroscopic knee surgery, in raarticular levobupivacaine co mbined with morphine and adr enaline de creases analgesic requirements, shortens the postoperative duration of analgesic use and hastens mobilization as effectively as bupivacaine.”