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Racemic bupivacaine has been used as a local anesthetic in medicine and dentistry for many years. The 2 main indications for its use in dentistry are lengthy procedures and management of postoperative pain, as in endodontic, surgical, and periodontal procedures, among others. 1 Although no case of toxicity has been documented in dentistry, a number of authors have reported its potent cardiac toxic effects, even in small doses. 2 Studies that compared racemic bupivacaine and levobupivacaine have shown less toxicity for the latter. 3 , 4 Since 2000, a

. Effects of Epinephrine on the Blood Flow of Levobupivacaine in the Rat Oral Mucosa—A Search by the Radioisotope (201TI) Clearance Method Kazuaki Hanzawa, Tetsuya Nagoh, Kimito Sano, Tomio Kanri J JPN DENT SOC ANESTHESIOL 2006 ; 34 : 472 - 477 . The present study was undertaken to examine the effects of 1:80,000 epinephrine (added to levobupiva-caine) on the blood flow through the oral mucosa, using the radioisotope ( 201 TI) clearance method. Twenty-four Wistar rats with a mean body weight of 613 ± 73 g were used for this study. An intraperitoneal

administered under intravenous sedation using propofol. Anesthetic Efficacy of Levobupivacaine With Epinephrine After Infiltration into The Palatal Mucosa In Rats Hideki Oda, Kiichi Taniyama, Kazuko Okawa, Katsuhito Himeno, Kouki Shikanai, and Tohru Shibutani, Department of Dental Anesthesiology, Matsumoto Dental University (Chief: Prof. Tohru Shibutain) Levobupivacaine is composed solely of S (−) bupivacaine, while bupivacaine is an equimolar mixture of enantiomers; R (+) and S (−) bupivacaine, Levobupivacaine has a lower potential for

enantiomers (50:50 mixtures). 24 The S(-)-enantiomers of bupivacaine and mepivacaine appear to be less toxic than the commercially available racemic mixtures of these local anesthetics. 24 It has been demonstrated that more S(-)- than R(+)-enantiomer of mepivacaine or bupivacaine is taken up by the lungs, thus reducing the concentration of the drug reaching the brain, where significantly more R(+)-enantiomer than S(-)-enantiomer is found. 25 Therefore, ropivacaine may be a safer long-acting amino-amide local anesthetic than levo-bupivacaine. In conclusion, the

administered to facilitate nasotracheal intubation via the right nostril with a reinforced 7.0-mm endotracheal tube. Anesthesia was maintained with continuous infusions of propofol administered as a target-controlled infusion to maintain a bispectral index of 40 to 60 (∼3.3 μg/mL during surgery) and remifentanil (0.2–0.4 μg/kg/min). A combination of 5 mL 2% lidocaine with 1:80,000 epinephrine and 5 mL 0.5% levobupivacaine (total dose: lidocaine 100 mg, epinephrine 0.0625 mg, levobupivacaine 25 mg) was administered via infiltration into the surgical areas prior to the

. , J. Ranali , G. M. Ambrosano , and M. C. Volpato . A double-blind comparison of 0.5% bupivacaine with 1∶200,000 epinephrine and 0.5% levobupivacaine with 1∶200,000 epinephrine for the inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol Oral Radiol Endodon 2006 . 101 : 442 – 447 . 14 Hinkley , S. A. , A. Reader , M. Beck , and W. J. Meyers . An evaluation of 4% prilocaine with 1∶200,000 epinephrine and 2% mepivacaine with 1∶20,000 levonordefrin compared with 2% lidocaine

, Sawa T, Amaya F. Dexmedetomidine prolongs levobupivacaine analgesia via inhibition of inflammation and p38 MAPK phosphorylation in rat dorsal root ganglion . Neuroscience . 2017 ; 361 : 58 – 68 . 18.  Huang Y, Lu Y, Zhang L

. Quality of analgesia after lower third molar surgery: a randomised, double-blind study of levobupivacaine, bupivacaine and lidocaine with epinephrine . Vojnosanit Pregl . 2015 ; 72 : 50 – 56 . 20 Obimakinde OS, Okoje VN, Olabode AI, Obimakinde AM. Role

maxillary anterior infiltration . Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 2001 ; 91 : 406 – 412 . 8. Bouaziz H , Iohom G , Estèbe JP , Campana WM, Myers RR. Effect of levobupivacaine and ropivacaine on rat sciatic nerve blood flow . Br J Anaesth . 2005 ; 95 : 696 – 700 . 9