Chirocaine (levobupivacaine) / Purdue, AbbVie - LARVOL DELTA

Ultrasound-Guided Suprainguinal Versus Infrainguinal Fascia Iliaca Compartment Block for Postoperative Analgesia After Total Knee Replacement: A Prospective Randomized Trial. (PubMed, Cureus) - "SFICB provides superior postoperative analgesia compared to IFICB in patients undergoing TKR, with reduced opioid requirement and prolonged analgesia duration."

Journal • Anesthesia • Musculoskeletal Diseases • Orthopedics • Pain

Efficacy of low-dose hypobaric anesthetics in spinal anesthesia for cesarean delivery: systematic review and meta-analysis. (PubMed, J Matern Fetal Neonatal Med) - "Systematic review and meta-analysis of eligible randomized controlled trials comparing the efficacy of low-dose spinal hypobaric anesthetics (Bupivacaine < 10 mg, levobupivacaine < 10 mg, ropivacaine < 15 mg) with conventional dose (Bupivacaine/Levobupivacaine ≥ 10 mg, ropivacaine ≥ 15 mg) in elective and subemergency Cesarean sections in data sources (PubMed, Embase, Web of Science, and Cochrane Central) from inception to February 2025. Furthermore, intrathecal opioid adjuvants improve anesthetic efficacy. The protocol for this systematic review was registered on PROSPERO (CRD42024533150)."

Journal • Retrospective data • Anesthesia • Cardiovascular • Dermatology • Hypotension • Pain • Pruritus

Ultrasound-guided lateral pterygoid muscle injection for inferior alveolar nerve block in sagittal split ramus osteotomy: a three-case series. (PubMed, JA Clin Rep) - "This novel lateral pterygoid muscle injection technique for perioperative analgesia demonstrates promising clinical efficacy through a simplified ultrasound-guided approach, providing effective opioid-free postoperative pain management for sagittal split ramus osteotomy."

Journal • Anesthesia • Orthopedics • Pain

Rapid Health Evaluation of Analgesia with Long-Acting Local Anesthesia After Hip and Knee Arthroplasty. (PubMed, Integr Pharm Res Pract) - "The quantitative scoring results were ranked from high to low as Dishili-Ropivacaine injection (75 points), Naropin-Ropivacaine injection (68.97 points), liposomal bupivacaine (65.06 points), bupivacaine injection (61.05 points), and levobupivacaine injection (60.35 points). The Dishili-Ropivacaine injection of the collectible variety is a strongly recommended variety, which is recommended to be introduced or retained in the drug catalog of medical institutions, and the Naropin-Ropivacaine injection and liposomal bupivacaine can be adjusted according to the actual situation and clinical needs of medical institutions."

Journal • Review • Anesthesia • Orthopedics • Pain

A Comparative Study of the Effect of Dexmedetomidine and Nalbuphine as an Adjuvant to Levobupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block: A Prospective Randomized Double-Blind Study. (PubMed, J Pharm Bioallied Sci) - "The subjects in both groups maintained stable hemodynamic conditions yet experienced mild bradycardia in Group D and mild sedation in Group N. The study revealed no severe adverse occurrences between any groups. Dexmedetomidine along with nalbuphine made levobupivacaine more effective in SCBPB, yet dexmedetomidine created longer-lasting effects on sensory and motor block while providing prolonged analgesic benefits."

Journal • Anesthesia • Cardiovascular • Pain

A Prospective Clinical Study to Assess the Hemodynamic Changes and Safety of 0.5% Levobupivacaine Hyperbaric for Spinal Anaesthesia in Adult Patients. (PubMed, J Pharm Bioallied Sci) - "Hyperbaric 0.5% levobupivacaine provides effective anesthesia with stable hemodynamics. However, shorter analgesia duration suggests a need for additional postoperative pain management."

Journal • Anesthesia • Cardiovascular • Hypotension • Pain

Patient Satisfaction With Single-Shot Spinal Analgesia for Labor: A Single-Center Study. (PubMed, Cureus) - "The analgesic mixture included 0.5% levobupivacaine (0.5 mL), fentanyl (25 mcg), and 0.9% NaCl (1 mL). Conclusion Single-shot spinal analgesia provided effective pain relief and high patient satisfaction, even among those who did not deliver during the period of analgesic effect. It offered parturients sufficient time to rest and actively participate in the final stage of labor."

Journal • Anesthesia • Infectious Disease • Novel Coronavirus Disease • Obstetrics • Pain

Combined lumbar erector spinae plane and femoral nerve block in open femoral artery pseudoaneurysm repair surgery, a case report (Euroanaesthesia 2025) - "This case report describes the use of a lumbar erector spinae plane (ESP) block as an alternative when neuraxial anesthesia is contraindicated.Case Report: A 78-year-old patient with COPD and atrial fibrillation on Warfarin underwent endograft placement for an abdominal aortic aneurysm...A lumbar ESP block was performed at L1-L2 transverse processes with 20 mL of 0.5% levobupivacaine, alongside a femoral nerve block with 10 mL of 0.5% lidocaine and 1% mepivacaine, plus light sedation with 5 mg of midazolam (RASS -1)...Given the variable sensory block associated with the ESP block [2], a femoral nerve block was added to ensure analgesia of the thigh's surgical area. Regarding anticoagulation, the ESP block's distance from major neural and vascular structures minimizes the risk of significant hematomas, despite theoretical concerns of compression in the erector spinae muscles."

Case report • Clinical • Surgery • Anesthesia • Atrial Fibrillation • Cardiovascular • Chronic Obstructive Pulmonary Disease • Immunology • Orthopedics • Pain • Respiratory Diseases

Comparison between epidural analgesia and intrathecal opioid analgesia for pain management in open nephrectomy: a prospective randomized controlled pilot study (Euroanaesthesia 2025) - "In this study, we compared two different approaches to pain management regarding acute pain during the first 24 hours.Materials and Patients undergoing open nephrectomy were randomized to one of the two groups: epidural analgesia (Control) or intrathecal opioid (Intervention) group.The intervention group received 300 mcg of morphine intrathecally before the general anesthesia, while the control group received a continuous infusion of levobupivacaine during the postoperative period. Intrathecal analgesia with morphine provides the same level of postoperative analgesia as epidural analgesia without an increased incidence of adverse effects."

Clinical • Anesthesia • Pain

Case report: Horner's syndrome following interscalene block in a 24-year-old female undergoing shoulder arthroscopy (Euroanaesthesia 2025) - "The anesthesia plan included a single-shot interscalene block with 15 mL of 0.25% levobupivacaine...In this case, imaging excluded other causes, confirming the block as the likely source.Previous reports suggest that HS may occur with higher volumes of anesthetic or suboptimal needle placement. However, in this case, the condition resolved without intervention, reinforcing its typically benign nature.Learning Points:Horner's syndrome is a rare but important complication of ISB caused by inadvertent sympathetic nerve blockade.The condition is usually transient and resolves without treatment.Early recognition is crucial to differentiate HS from other neurological conditions.Proper technique and volume control during ISB can help minimize the risk of sympathetic nerve involvement."

Case report • Clinical • Anesthesia • Ophthalmology • Orthopedics

Efficacy of nalbuphine as an adjuvant to levobupivacaine scalp nerves block on postoperative analgesia in elective supratentorial craniotomy - a randomized double-blinded clinical trial (Euroanaesthesia 2025) - "There was no difference in HR and the postoperative adverse events between groups.Conclusion(s): The addition of 10 mg of nalbuphine to 0.25% levobupivacaine for preoperative SNB did not prolong post-craniotomy opioid-free duration. However, nalbuphine can reduce intraoperative and 24-hour fentanyl consumption in elective supratentorial craniotomy patients."

Clinical • Anesthesia • Cardiovascular • Hypertension • Pain

Levobupivacaine interacting with a self-assembling peptide to form a slow-releasing formulation for long-acting analgesia (Euroanaesthesia 2025) - "The nerve block duration for 4% LB@EAY formulation lasted for 20.25 ± 7.42 hr, which was significantly longer than that for 0.75% LB hydrochloride (4.00 ± 1.11 hr) and 1.33% bupivacaine liposome (4.67 ± 1.51 hr). In addition, local injury scores for 4% LB@EAY including inflammatory cell infiltration, myocytotoxicity and axonal degeneration at 4 and 14 days after injection were similar to those for 0.75% LB hydrochloride, indicating the safety of formulation.Conclusion(s): The self-assembling peptide EAY could high efficiently encapsulate LB to form stable slow-releasing formulation with long-acting nerve block."

Anesthesia • Pain

Postoperative pain management with opioid free intravenous pump infusion after sleeve gastrectomy - a case series (Euroanaesthesia 2025) - "Magnesium sulphate (2,5gr), dexamethasone (8mg), dexketoprofen (50mg), fentanyl (100μg) and oxycodone (8mg) were given before skin incision. Propofol and rocuronium were used for induction of anaesthesia and desflurane for maintenance. Intraoperative pain management included lidocaine (1mg/kg IBW/h) and esmolol infusion -according to sympathetic stimulation, along with remifentanil (50μg/ml) in low dose...At the end of operation 1gr of paracetamol and 2mg of oxycodone was given in addition to wound infiltration with levobupivacaine 0.25%.Postextubation an infusion pump of nonopioids was initiated (0,5ml/10kg IBW/h). It was a mixture of dexmedetomidine (100μg), lidocaine (1gr) and ketamine (100mg) in N/S (total volume 100ml) according to Mulier's protocol (Mulimix). Additionally paracetamol (1gr) quid and ondansetron (4mg) bid were prescribed...No side effects were recorded. A larger sample of patients should be recruited to solidify these results."

Clinical • Anesthesia • Gastrointestinal Disorder • Obesity • Pain

Peng block as part of multimodal analgesia for pain management in hip arthroplasty (Euroanaesthesia 2025) - "The following data was evaluated during the first 48 postoperative hours: ENA scale, analgesic medication used, milligrams of dexamethasone administered, opioid consumption, side effects, recovery time from the anesthetic block, time to the onset of sitting and ambulation, and length of hospital stay.Results and • 76.6% received a complete multimodal analgesic treatment, which consisted of the administration of an analgesic (paracetamol), a NSAID (dexketoprofen or ibuprofen), and intraoperative dexamethasone, along with the performance of a PENG block (levobupivacaine 0.25%, 20 ml).• 60% of the patients received a dose of dexamethasone ≥ 10 mg. In patients with complete treatment who received a dose of dexamethasone ≥ 10 mg, the average morphine consumption was 2.31 mg.Conclusion(s): We observed that the PENG block is a safe and effective block. However, further studies are still needed to determine the optimal timing and dosage for its administration."

Anesthesia • Orthopedics • Pain

The ascending reticular activating system and its implications in neuraxial anesthesia: coma secondary to epidural anesthesia: a case report (Euroanaesthesia 2025) - "A 2% lidocaine test dose (3 cc) was negative, followed by 0.125% levobupivacaine (fractioned 10ml)...Further research into ARAS-related mechanisms in neuraxial anesthesia is essential to improve perioperative safety.Learning Points: Epidural anesthesia poses rare risks such as transient coma. ARAS involvement in consciousness regulation highlights the need for further investigation into neuraxial anesthesia's neurological impacts."

Case report • Clinical • Addiction (Opioid and Alcohol) • Anesthesia • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Diabetes • Endocrine Disorders • Hypertension • Ischemic stroke • Metabolic Disorders • Musculoskeletal Diseases • Nephrology • Orthopedics • Pain • Pulmonary Embolism • Renal Disease • Respiratory Diseases

Divergent interpretations between the CONOX monitor and Surgical Plethysmographic Index (SPI) on the nociceptive response during open hemihepatectomy (Euroanaesthesia 2025) - "A thoracic epidural catheter was placed at T9 with 0.125% Levobupivacaine infusion...In this particular case, the SPI misinterpretation could have led to overadministration of analgesics, potentially compromising patient safety.The presented clinical situation highlights the need for careful interpretation of data provided by these tools and the importance of contextualizing information within the clinical and surgical scenario.Learning points: : While CONOX and SPI are valuable tools for monitoring nociception, it is essential to understand their mechanisms and potential limitations. Proper and contextualized interpretation is vital to ensure patient welfare and safety in the operating room."

Anesthesia • Pain

Remimazolam with peripheral nerve blocks as sole sedative agent for ASA 4 joint arthroplasty revision patients (Euroanaesthesia 2025) - "5 mg i.v as initial bolus on induction with 2.5 mg increments along with Ultra sound guided Fascia illiaca block with 30 ml 0.25 Levobupivacaine. Its 'inactive' metabolite (300 x less active than parent compound ). Its use in ASA 4 cases with multiple co-morbidity in small doses is safe and gives sedation and hypnosis with amnesia."

Clinical • Alzheimer's Disease • Anesthesia • Chronic Obstructive Pulmonary Disease • CNS Disorders • Dementia • Depression • Hypotension • Immunology • Infectious Disease • Orthopedics • Psychiatry • Respiratory Diseases

Intermittent bolus vs. continuous infusion after paravertebral block for thoracic surgeries: a systematic review and meta-analysis< (Euroanaesthesia 2025) - "One study used bupivacaine (0.25 - 0.375%), three studies used levobupivacaine (0.2 - 0.5%), and four studies used ropivacaine (0.2 - 0.75%). Similarly, there was no difference in the need for rescue analgesics (RR 1.07, 95% CI 0.65 to 1.75, p=0.80, Figure C).Conclusion(s): Intermittent bolus delivery and a continuous infusion for PVB in thoracic surgeries appear to be equally effective for postoperative analgesia. Nonetheless, the differences in volume and concentrations of local anaesthetic, frequency of bolus delivery, use of ultrasound, and minimally invasive vs. open surgery impaired a more granular assessment of the findings."

Retrospective data • Review • Surgery • Anesthesia • Pain • Respiratory Diseases

Anaesthetic challenges in a case of Uremic Leontiais Ossea for left cephalic vein pseudo aneurysm rupture repair (Euroanaesthesia 2025) - "After obtaining high risk consent ,patient was given left infraclavicular block with PNS guidance, with 20 ml of 0.5 percent levobupivacaine at current threshold of 0.4 mA...Case was done successfully without any periprocedural complications. Uremic leontiasis ossea is a rare condition that occurs with renal failure on hemodialysis with secondary hyperparathyroidism characterized by widening of nares, flattened nasal bridge, maxillary and mandibular hyperplasia.We are reporting first time this condition done under regional anaesthesia, infraclavicular block for psedonaurysm rupture repair. Infra clavicular block is a phrenic nerve sparing block for surgeries for mid arm and forearm."

Clinical • Anesthesia • Cardiovascular • Chronic Kidney Disease • Endocrine Disorders • Nephrology • Renal Disease • Secondary Hyperparathyroidism

Quadratus lumborum and piriformis muscle infiltration, a new approach for low back pain in pregnant patients: case reports (Euroanaesthesia 2025) - "In this case, the LBP radiated from her right lower back pain to her posterior thigh and only partially improved with optimized medical therapy.In both cases, following informed consent, an ultrasound-guided injection was performed, administering a combination of levobupivacaine and betamethasone into the quadratus lumborum and piriformis muscles...A multimodal management of LBP is recommended for optimizing outcomes in pregnant patients. In this case, we suggest an alternative strategyinvolving the targeted infiltration of local anesthetic and corticosteroid into the fascial planes compressing the sciatic nerve.Learning points: We believe this approach has the potential to provide effective and lasting analgesia for pregnant patients with radicular pain while minimizing side effects."

Case report • Clinical • Addiction (Opioid and Alcohol) • Anesthesia • Back Pain • Lumbar Back Pain • Musculoskeletal Pain • Obesity • Pain • Renal Calculi

Ultrasound-assisted neuraxial anesthesia: a safe approach in ankylosing spondylitis (Euroanaesthesia 2025) - "Dural puncture was successfully achieved using a 25-gauge Whitacre needle, and 11 mg of levobupivacaine and 0.002 mg of sufentanil (total volume of 2.6 mL) were administered intrathecally...Comparing with the conventional method, this approach enhances clinical accuracy by anticipating the feasibility of a central neuraxial blockade and can improve patient safety. This enables anesthesiologists to offer regional anesthesia as an alternative to general anesthesia for patients with abnormal spinal anatomy who would also benefit from a regional approach."

Anesthesia • Ankylosing Spondylitis • Cardiovascular • Genetic Disorders • Hypertension • Immunology • Inflammatory Arthritis • Obesity • Orthopedics • Rheumatology • Seronegative Spondyloarthropathies

Hemodynamic effect of remimazolam compared with sevoflurane in thoracic surgery (Euroanaesthesia 2025) - "After that 3-4 mcg/kg of fentanyl and 0.6 mg/kg of rocuronium was administered and a proper size of double-lumen endobronchial tube was intubated and arterial catheter was placed at either side of radial artery and arterial blood pressure was continuously monitored.In RM group, anesthesia was maintained by remimazolam...In sevoflurane group, anesthesia was maintained with sevoflurane at expired concentration of 1.1-1.3%.For epidural analgesia, 1% lidocaine (7-9 mL) was given initially, followed by 0.25% levobupivacaine (7-9 mL) 30 minutes later...Frequency of vasopressor use was 0 [0, 0.97] in RM group and was significantly less compared with 1.55 [0.65, 2.90] in SV group (median [25th, 75th]). 48 cases (57.8%) in RM group were vasopressor free while 8 cases (9.5%) in SV group.Conclusion(s): Decrease of blood pressure was much less in remimazolam anesthesia compared with that in sevoflurane anesthesia even with thoracic epidural anesthesia."

Surgery • Anesthesia • Hypotension • Lung Cancer • Oncology • Solid Tumor

Comparison of analgesic efficacy of levobupivacaine with or without fentanyl in thoracolumbar inter-fascial plane block in adults undergoing elective lumbar spine surgery: a randomized control trial (Euroanaesthesia 2025) - "The addition of fentanyl as an adjuvant to levobupivacaine in TLIP blocks provides superior analgesia, with a longer pain-free duration, delayed requirement for rescue analgesia, and reduced total rescue analgesic consumption in patients undergoing elective lumbar spine surgeries."

Clinical • Surgery • Anesthesia • Orthopedics • Pain

Comparison of standard versus walking epidural anesthesia: clinical implications for labor pain management. A prospective cohort study (Euroanaesthesia 2025) - "This study evaluates the analgesic effectiveness, motor blockade, and maternal satisfaction of standard epidural versus walking epidural.Materials and This prospective, blind cohort, observational study included 90 laboring parturients, divided into three groups: 30 received standard epidural (SE) anesthesia (levobupivacaine 0.125% + 1 mcg/ml fentanyl or ropivacaine 0.15% + 1mcg/ml of fentanyl), while 60 received walking epidural (WE) anesthesia (30 with levobupivacaine 0.0625% + fentanyl 2 mcg/mL, and 30 with ropivacaine 0.075% + fentanyl 2 mcg/mL). SE anesthesia offers superior analgesia and slightly higher satisfaction compared to WE, albeit with reduced mobility. Both techniques are safe and effective. These findings support individualized anesthesia choices, balancing the desire for mobility with the need for optimal pain relief."

Clinical • Anesthesia • Pain

Crystallization and pharmacological stability of local anesthetics in mixtures with dexamethasone for perineural administration (Euroanaesthesia 2025) - "The hydrogen index of solutions of local anesthetics and their mixtures with dexamethasoneFigure 1. a) 0.33% solution of ropivacaine and dexamethasone ×200; b) 0.33% solution of levobupivacaine and dexamethasone ×200"

Anesthesia