Background and Objectives: Bupivacaine is available as a racemic mixture of dextrobupivacaine and levobupivacaine. Many studies show that dextrobupivacaine has a greater inherent central nervous system and cardiovascular toxicity than levobupivacaine. The aim of the present study was to investigate the clinical efficacy and safety of levobupivacaine compared with racemic bupivacaine for extradural anesthesia.
Meterial and Method: The authors studied 61 patients undergoing elective cesarean delivery who received either 0.5% levobupivacaine (n = 31) or 0.5% bupivacaine (n = 30) extradurally, in a randomized, double blind study.
Results: The 2 groups were similar in terms of time to block suitable for surgery, duration of sensory block, time to T10 regression, time to onset and offset of motor block, verbal numeric pain scores at abdominal opening and at child birth. Mean (SD) dose of 0.5% levobupivacaine and 0.5% bupivacaine were 19.3 (4.6) ml and 17.3 (3.8) ml respectively, p = 0.069.
Conclusion: Levobupivacaine produces an extradural block that is similar to bupivacaine, and is an alternative to bupivacaine for cesarean delivery patients.

Keywords: Regional anesthesia, Extradural, Local anesthetics, Levobupivacaine, Obstetrics, Cesarean delivery