Search

Background Levobupivacaine is an effective local anaesthetic agent for nerve blockade with less systemic toxicity than racemic bupivacaine. The safety and efficacy of levobupivacaine for scalp blockade during awake craniotomy have not been addressed previously. Methods Serial arterial plasma levobupivacaine concentrations following scalp blockade were measured to 2 h in 10 patients booked for awake craniotomy for epilepsy or tumour surgery. Bilateral scalp blockade providing surgical anaesthesia was achieved with a mean dose of 177 mg (2.5 mg kg−1, range 1.6–3.2 mg kg−1) of levobupivacaine (0.5%, 5 mg ml−1) with epinephrine (5 μg ml−1) added immediately before the block insertion. Results The maximum measured plasma levobupivacaine concentration was 1.58 (0.44) μg ml−1 [mean ( sd )] with a mean time to peak plasma concentration of 12 (4) min. There were no episodes in any of the 10 patients of symptoms or signs suggestive of either CNS or CVS toxicity. Conclusions This study demonstrated a relatively rapid rise of plasma levobupivacaine concentration without evidence of cardiovascular or central nervous system sequelae in a sample population of patients who may be particularly prone to perioperative seizures.

The plasma levels of ropivacaine HCl with 5 mcg/mL epinephrine were measured in 10 patients following scalp blockade for awake craniotomy. A mean dose of 260 mg (3.6 mg/kg) resulted in peak plasma concentrations of 1.5 +/- 0.6 mcg/mL, with a median time to peak plasma concentration of 15 minutes. The pattern of rise of plasma level was similar in all patients and rapid compared with other regional blocks (epidural, intercostal, and axillary brachial plexus block). Despite this rapid rise of plasma level, no signs of cardiovascular or central nervous system toxicity were observed. In this group of patients undergoing awake craniotomy for excision of lesions in the eloquent areas of the cerebral cortex, ropivacaine HCl with epinephrine appeared to be a safe and effective local anesthetic agent in the dosages used.