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BJA Advance Access published online on April 7, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei135
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted February 23, 2005

Clinical Investigation

Plasma levobupivacaine concentrations following scalp block in patients undergoing awake craniotomy

T. G. Costello 1, J. R. Cormack 1*, L. E. Mather 2, B. LaFerlita 1, M. A. Murphy 3, and K. Harris 1

1 Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia
2 Department of Anaesthesia and Pain Management, University of Sydney at Royal North Shore Hospital, Sydney, NSW, Australia
3 Department of Neurosurgery, St Vincent's Hospital, Melbourne, Victoria, Australia

* To whom correspondence should be addressed.
J. R. Cormack, E-mail: cormackj{at}ozemail.com.au


  Abstract

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.

Keywords: anaesthetics local, levobupivacaine; scalp blocks; surgery, awake craniotomy; toxicity.
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