Levobupivacaine is a long acting, amide-type local anaesthetic and is the S(-)-enantiomer of racemic bupivacaine. The majority of in vitro, in vivo and human pharmacodynamic studies indicate that levobupivacaine has a similar potency to bupivacaine in various types of nerve blocks. However, levobupivacaine has a lower risk of cardiovascular and CNS toxicity than bupivacaine. Randomised, double blind clinical studies established that the anaesthetic and/or analgesic effects of levobupivacaine were very similar to those of bupivacaine of thesame dose.The sensory block tended to be a little bit longer with levobupivacaine than bupivacaine. Levobupivacaine was generally as effective as bupivacaine for regional anaesthesia for various types of surgery, for pain management during labour, and for postoperative pain management, especially when combined with opioids, or clonidine. The tolerance profiles of levobupivacaine and bupivacaine were very similar. The most common adverse event associated with levobupivacaine administration was hypotension. Excluding pharmacoeconomic considerations, levobupivacaine is an appropriate choice for use in place of bupivacaine.

        Key words: bupivacaine – levobupivacaine – ropivacaine – local anaesthetics – cardiotoxicity – CNS toxicity