نبذة مختصرة : This study highlights the use of levobupivacaine as a substitute for lignocaine in the treatment of two patients with documented adverse reactions to lignocaine. Lignocaine, the most widely used local anesthetic, can trigger allergies and other adverse effects. Allergic reactions can be mild, ranging from urticaria, erythema, and pruritus, to severe reactions in the form of angioedema and bronchospasm. In patients with a documented allergy to lignocaine, options for analgesia during nonsurgical rejuvenation include other amide-based local anesthesia, light sedation, or general anesthesia. Two patients with documented allergies to lignocaine underwent nonsurgical rejuvenation with levobupivacaine as the local anesthetic and reconstitution agent for Ellanse M. Levobupivacaine, chosen for its lower central nervous system and cardiovascular toxicity compared to those of racemic bupivacaine, has dual functions: local anesthesia and reconstitution of Ellanse. Ellanse is a collagen stimulator composed of polycaprolactone microspheres embedded in carboxymethylcellulose (CMC) gel distributed by Sinclair Pharmaceutical. It produces a natural aesthetic result through collagen stimulation. The 2 patients tolerated levobupivacaine as the choice of local anesthesia, with no adverse events. The reconstituted Ellanse was treated using a 27 G needle as well as a 25 G 50 mm cannula. The extrusion force was uniform and no needle or cannula jams were found. During 1-month assessment, the injected Ellanse volume decreased owing to resorption of the CMC gel, and during 3-month assessment, neocollagenesis was observed. Levobupivacaine is a suitable alternative to lignocaine as it enables patients with lignocaine allergies to undergo nonsurgical facial rejuvenation with Ellanse. Levobupivacaine offers comparable efficacy and safety profiles, making it a valuable option for anesthesia and reconstitution in such cases. Level of Evidence: Level V (Case Series)
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