title: Plasma levobupivacaine concentrations following scalp block in patients undergoing awake craniotomy.
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 microg ml(-1)) added immediately before the block insertion.
  
  
  RESULTS
  The maximum measured plasma levobupivacaine concentration was 1.58 (0.44) microg 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.
authors.affiliation: Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: T G
authors.initials: TG
authors.lastname: Costello
authors.forename: J R
authors.initials: JR
authors.lastname: Cormack
authors.forename: L E
authors.initials: LE
authors.lastname: Mather
authors.forename: B
authors.initials: B
authors.lastname: LaFerlita
authors.forename: M A
authors.initials: MA
authors.lastname: Murphy
authors.forename: K
authors.initials: K
authors.lastname: Harris
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000097:blood*; D001932:Brain Neoplasms / Q000601:surgery; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000097:blood*; D003399:Craniotomy / Q000379:methods*; D004827:Epilepsy / Q000601:surgery; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D012535:Scalp
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine