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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Levobupivacaine - Drugs and Lactation Database (LactMed®) - NCBI Bookshelf</title>
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<meta name="citation_keywords" content="L(-)-Bupivacaine">
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<meta name="citation_keywords" content="Levobupivacaina">
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<meta name="citation_keywords" content="27262-47-1">
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<meta name="citation_keywords" content="Levobupivacaine [INN:BAN]">
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class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK501605_"><span class="title" itemprop="name">Levobupivacaine</span></h1><p class="fm-aai"><a href="#_NBK501605_pubdet_">Publication Details</a></p><p><em>Estimated reading time: 3 minutes</em></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><p>CASRN: 27262-47-1</p><a href="https://pubchem.ncbi.nlm.nih.gov/substance/135048182" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=135048182" alt="image 135048182 in the ncbi pubchem database" /></a><div id="LM709.Drug_Levels_and_Effects"><h2 id="_LM709_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM709.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Levobupivacaine is no longer marketed in the US. Levels in breastmilk are low, and it is poorly absorbed orally by the infant. Bupivacaine, the racemic mixture of dextro- and levobupivacaine, has not caused any adverse effects in breastfed infants.</p><p>Local anesthetics <i>during</i> labor and delivery with other anesthetics and analgesics has been reported by some to interfere with breastfeeding. However, this assessment is controversial and complex because of the many different combinations of drugs, dosages and patient populations studied as well as the variety of techniques used. In contrast, epidural local anesthetics begun <i>after</i> clamping of the umbilical cord appears to enhance breastfeeding success because of improved pain control. Overall, it appears that with good breastfeeding support epidural levobupivacaine with or without fentanyl or one of its derivatives has little or no adverse effect on breastfeeding success.[<a class="bibr" href="#LM709.REF.1" rid="LM709.REF.1">1</a>-<a class="bibr" href="#LM709.REF.6" rid="LM709.REF.6">6</a>] Labor Labor pain medication may delay the onset of lactation. In one study, adding levobupivacaine wound infiltration to multimodal analgesia after cesarean section improved breastfeeding comfort.</p></div><div id="LM709.Drug_Levels"><h3>Drug Levels</h3><p><i>Maternal Levels.</i> Twenty women undergoing cesarean section deliveries with epidural anesthesia were randomized to receive either levobupivacaine 0.5% (n = 10) or bupivacaine 0.5% (n = 10) in a single-blinded study. The drugs were given as 0.5 mL (2.5 mg) boluses as needed up to 150 mg (mean 80 mg). Blood and milk samples were obtained before and 0.5, 1, 2, 6, 12 and 24 hours after administration of the drugs. Levobupivacaine was detected in breastmilk 30 minutes after administration, with the peak milk concentration of about 0.25 mg/L occurring at about 2 hours after administration. Levobupivacaine was almost at baseline level by 7 hours and absent from milk (<5 mcg/L) by 24 hours after the dose. The passage of racemic bupivacaine into breastmilk was virtually identical.[<a class="bibr" href="#LM709.REF.7" rid="LM709.REF.7">7</a>]</p><p><i>Infant Levels.</i> Relevant published information was not found as of the revision date.</p></div><div id="LM709.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>Relevant published information on levobupivacaine was not found as of the revision date. However, bupivacaine administered to the mother by intrapleural or epidural routes had no effect on 13 breastfed infants.[<a class="bibr" href="#LM709.REF.8" rid="LM709.REF.8">8</a>]</p></div><div id="LM709.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>A nonrandomized convenience sample of women who did (n = 209) or did not (n = 157) receive epidural analgesia during labor was analyzed to determine whether epidurals affected the onset of lactation. Although not standardized, the typical procedure used sufentanil 10 to 15 mg together with either ropivacaine 0.1% or levobupivacaine 0.0625% epidurally, supplemented by epidural boluses of ropivacaine 0.1% or levobupivacaine 0.0625% about every 2 hours. No difference was found in the time of lactation onset between the two groups. Although women in both groups stated they wished to breastfeed prior to delivery, exclusive breastfeeding at 20 days postpartum was less frequent in the women who received an epidural (43%) than in women who did not (57%).[<a class="bibr" href="#LM709.REF.9" rid="LM709.REF.9">9</a>]</p><p>A randomized, unblinded study of women undergoing cesarean section found that women who received postoperative wound infiltration with levobupivacaine. A bolus of 50 mg was infused subfascially 5 cm lateral to the wound incision, followed by 6.25 mg/hour for 48 hours. Additional analgesia included acetaminophen, celecoxib, nefopam, morphine and droperidol. On day 2 postpartum, women who received the levobupivacaine infusion reported more comfort with breastfeeding. More women who received the levobupivacaine were breastfeeding on day 2, but the difference was not statistically significant.[<a class="bibr" href="#LM709.REF.10" rid="LM709.REF.10">10</a>]</p><p>A retrospective medical record study in China compared women who received patient-controlled epidural analgesia during labor (n = 527) to those who did not (n = 395). Epidural analgesia included 0.1% levobupivacaine and 5 mg of sufentanil in 10 mL of saline. All women completed a questionnaire regarding their breastfeeding experience at 6 months postpartum. There were no statistically significant differences between the groups in the proportion who initiated breastfeeding within 1 hour after birth or who exclusively or partially breastfed their infants at 1, 3, or 6 months postpartum.[<a class="bibr" href="#LM709.REF.11" rid="LM709.REF.11">11</a>]</p></div><div id="LM709.Alternate_Drugs_to_Consider"><h3>Alternate Drugs to Consider</h3><p><a href="/books/n/lactmed/LM363/?report=reader">Lidocaine</a>, <a href="/books/n/lactmed/LM617/?report=reader">Ropivacaine</a></p></div><div id="LM709.References"><h3>References</h3><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="LM709.REF.1">Reynolds F. Labour analgesia and the baby: Good news is no news. <span><span class="ref-journal">Int J Obstet Anesth. </span>2011;<span class="ref-vol">20</span>:38–50.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21146977" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21146977</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="LM709.REF.2">Loubert C, Hinova A, Fernando R. Update on modern neuraxial analgesia in labour: A review of the literature of the last 5 years. <span><span class="ref-journal">Anaesthesia. </span>2011;<span class="ref-vol">66</span>:191–212.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21320088" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21320088</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="LM709.REF.3">Shrestha B, Devgan A, Sharma M. Effects of maternal epidural analgesia on the neonate--a prospective cohort study. <span><span class="ref-journal">Ital J Pediatr. </span>2014;<span class="ref-vol">40</span>:99.</span> [<a href="/pmc/articles/PMC4297456/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4297456</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25492043" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25492043</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="LM709.REF.4">Zuppa AA, Alighieri G, Riccardi R, et al. Epidural analgesia, neonatal care and breastfeeding. <span><span class="ref-journal">Ital J Pediatr. </span>2014;<span class="ref-vol">40</span>:82.</span> [<a href="/pmc/articles/PMC4335561/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4335561</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25432659" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25432659</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="LM709.REF.5">French CA, Cong X, Chung KS. Labor epidural analgesia and breastfeeding: A systematic review. <span><span class="ref-journal">J Hum Lact. </span>2016;<span class="ref-vol">32</span>:507–20.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27121239" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27121239</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="LM709.REF.6">Heesen P, Halpern SH, Beilin Y, et al. Labor neuraxial analgesia and breastfeeding: An updated systematic review. <span><span class="ref-journal">J Clin Anesth. </span>2020;<span class="ref-vol">68</span>:110105. </span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33069970" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33069970</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="LM709.REF.7">Bolat E, Bestas A, Bayar MK, et al. Evaluation of levobupivacaine passage to breast milk following epidural anesthesia for cesarean delivery. <span><span class="ref-journal">Int J Obstet Anesth. </span>2014;<span class="ref-vol">23</span>:217–21.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24953218" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24953218</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="LM709.REF.8">Ortega D, Viviand X, Lorec AM, et al. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. <span><span class="ref-journal">Acta Anaesthesiol Scand. </span>1999;<span class="ref-vol">43</span>:394–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10225071" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10225071</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="LM709.REF.9">Mauri PA, Contini NN, Giliberti S, et al. Intrapartum epidural analgesia and onset of lactation: A prospective study in an Italian birth centre. <span><span class="ref-journal">Matern Child Health J. </span>2015;<span class="ref-vol">19</span>:511–8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24894732" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24894732</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="LM709.REF.10">Jolly C, Jathieres F, Keita H, et al. Cesarean analgesia using levobupivacaine continuous wound infiltration: A randomized trial. <span><span class="ref-journal">Eur J Obstet Gynecol Reprod Biol. </span>2015;<span class="ref-vol">194</span>:125–30.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26366789" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26366789</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="LM709.REF.11">Xu Q, Wu ZF, Yang NN, et al. Impact of epidural analgesia during labor on breastfeeding initiation and continuation: A retrospective study. <span><span class="ref-journal">J Matern Fetal Neonatal Med. </span>2020;<span class="ref-vol">33</span>:3816–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30890010" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30890010</span></a>]</div></dd></dl></dl></div></div><div id="LM709.Substance_Identification"><h2 id="_LM709_Substance_Identification_">Substance Identification</h2><div id="LM709.Substance_Name"><h3>Substance Name</h3><p>Levobupivacaine</p></div><div id="LM709.CAS_Registry_Number"><h3>CAS Registry Number</h3><p>27262-47-1</p></div><div id="LM709.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Anesthetics, Local</p></div></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></dl></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK501605_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Revision: <span itemprop="dateModified">April 19, 2021</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a><p class="small"><b>Attribution Statement:</b> LactMed is a registered trademark of the U.S. Department of Health and Human Services.</p></div></div><h3>Publisher</h3><p><a href="https://www.nlm.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Child Health and Human Development</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Levobupivacaine. [Updated 2021 Apr 19].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/lactmed/LM292/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/lactmed/LM156/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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