International literature shows how local anesthesia is certainly more advantageous in terms of costs for the structure. While there are no particular differences between regional and general anesthesia, local anesthesia results seem to be better. A potential advantage of local anesthesia realized without any monitoring or additional drugs administered intravenously (the so-called local anesthesia not monitored) .
Levobupivacaine is a local anesthetic with long duration of action. It works by blocking nerve conduction of sensory and motor nerves, interacting predominantly with the voltage-gated sodium channels in the membrane of the cell, but also blocking potassium channels and calcium. Levobupivacaine also interferes with the transmission of the pulse and the conduction in other tissues where the effects on the central nervous system and cardiovascular system are the most important for the occurrence of clinical adverse reactions. Chirocaine is a compound based levobupivacaine hydrochloride. It is capable of producing a block on both the sympathetic system and on the parasympathetic system demonstrating hemodynamic changes significantly milder than Ropivacaine, which instead has the greatest influence on the sympathetic system with respect to that parasympathetic . The dose of levobupivacaine is expressed as a basis, unlike the racemic Bupivacaine where the dose is expressed as a hydrochloride salt. This roughly translates into a 13% more active ingredient in the solutions of levobupivacaine compared to those of bupivacaine. As regards to the pharmacokinetic properties, in human trials, the kinetics of distribution of levobupivacaine after intravenous administration are essentially the same as bupivacaine. The plasma concentration of levobupivacaine following therapeutic administration depends on the dose and, as absorption from the site of administration is influenced by the vascularity of the tissue, the route of administration. It is available in two formulations: Vial of 10 ml polypropylene, in pack sizes of 5, 10 and 20 units, polipropilene vial of 10 ml in sterile blister packs of 5, 10 and 20 units. Chirocaine can be worked in a very large number of surgical procedures, can be administered in major surgery for epidural, intrathecal, in nerve conduction block device, in minor surgery for local infiltration and for ophthalmic use in order to obtain a peribulbar block. It could be used in the treatment of pain, as an analgesic in the course of delivery, both for bolus infusion, and also for the post-operative pain. Among the uses of Chirocaine there are scientifically proven mastopexy interventions . Levobupivacaine is more effective to obtain analgesia with local infiltration compared to Ropivacaine, providing analgesia for postoperative period. Interventions of septoplasty and rhinoseptoplasty with an infiltration of levobupivacaine at 0.25% in the nasal region improve the post-operative analgesia and reduce the demand for additional analgesia during the twenty-four hours following nasal surgery. The post-operative analgesia achieved through the local infiltration of levobupivacaine has been demonstrated to be significantly more powerful and showed longer duration compared to the association lidocaine plus epinephrine. The same holds with regard to the interventions of mini-abdominoplasty . In this case levobupivacaine has proved to be more effective and with a duration indeed higher than ropivacaine. Levobupivacaine can be the agent of first choice in the thoracic epidural block  , compared to the use of a Ropivacaine dose equivalent. It has also proved effective even in the interventions of arthroscopy and Carotid Endarterectomy .
Especially in recent years local anesthesia allows the surgeon to monitor patients and to have simultaneously shorter hospitalization times and lower costs for the structure. Local anesthesia applied during endarterectomy surgery allows the surgeon to assess the levels of cerebral perfusion in an awake patient, giving a better chance of cerebral protection during arterial clamping. All these elements indicate that such interventions performed under local anesthesia with levobupivacaine compounds offer greater chances of success with significantly reduced rates of morbidity and mortality [12–14].
Locally hernioplasty has proved to be the method with the minor impact on the functioning of organs and systems, as it appears to be safe, effective, with a low incidence of side effects, enabling a rapid mobilization of the patient and significantly reducing the time of hospitalization, in less than twenty-four hours .
Among rare complications of surgery, hernioplasty under local anesthesia include: cardiovascular instability, nausea, vomiting, urinary retention, scrotal hematoma, edema, infection, orchitis, testicular atrophy and recurrences. Normally this type of surgery shows a lower incidence of complications than the same operation performed with general anesthesia. Compared with other types of anesthesia, post-operative complications of the respiratory and circulatory systems are significantly reduced .
The use of local anesthesia also allows the patient to be awake, aware, and thus able to collaborate actively conducting a stress-test by performing the Valsalva maneuver or a cough, which allows the surgeon to evaluate intra-operatively the presence of defects, latent trusses and sealing of the repair of plastic, reducing significantly the proportion of surgical failures [17, 18].
The anesthetic block consists of four phases: The first phase, percutaneous, provides the block troncular selective ilioinguinal nerves and iliohypogastric. The second phase, percutaneous, blocks the genital branch of the genitofemoral nerve, through a puncture performed below the inguinal ligament, lateral to the pubic tubercle. The third phase, percutaneous, provides for the infiltration of the surgical incision using a 22 gauge spinal needle. The anesthetic block is completed in the incisional phase by means of an open infiltration performed in each anatomical floor during the course of surgery . Local anesthesia with levobupivacaine and bupivacaine is now a established and safe procedure with risks considerably reduced, a quick and full recovery of the patient's general condition and an immediate return to normal working activities. Data from the international literature indicate how the levobupivacaine is less toxic compared to bupivacaine, both at the cardiac level and at the neurological level [20, 21].
The purpose of this study was to compare the perception of pain intra and post-operative, found as a result of intervention with the Levobupivacaine, compared to that recorded after the same intervention carried out with the racemic bupivacaine. We used the same dose for both anesthetics. The forty patients we studied, were randomly distributed in two groups, and were classified on the basis of a number of variables: age, weight, sex, type of hernia, ASA Stadium and location of the hernia. The first point on which we focused was intra-operative pain. In the group of patients treated with levobupivacaine, 10 % reported minimal pain, 55% mild pain, 30% moderate pain, 5% severe pain. In the group of patients treated with bupivacaine, 10% identified minimal pain, 65% mild pain, 25% moderate pain and no one intense pain. Therefore, we can say that minimal pain is the same in both groups. Mild pain was more frequent in the bupivacaine group, moderate pain slightly more frequent in the Levobupivacaine group and the same for intense pain. The second point on which we focused was post-operative pain, assessed in three positions within 48 hours. In the first group, 10% of patients reported pain in the supine position, 15% in the sitting position and 10% standing up. In the second group, 10 % reported pain in the supine position, 15% in the sitting position and 15% standing up. Therefore the data show the same results for the first two positions and a slight preference for levobupivacaine in the upright position. With regard to the assessment of pain during the forty-eight hours, we evaluated the impressions of the patient's at four time intervals: four, twelve, twenty-four and forty-eight hours. In the levobupivacaine group, 15% of patients expressed pain relief after four hours, 10% after 24 hours, 5% after 48 hours. In the bupivacaine group, 10% of patients experienced pain after four and twelve hours, 5% after twenty-four and forty-eight hours. It is therefore evident how Bupivacaine is preferred slightly after four and twenty four hours, while the two drugs appear to be equivalent at a distance of twelve and forty-eight hours. The third point we considered werethe postoperative complications and overall patient satisfaction. In the Levobupivacaine group, 20% experienced symptoms such as nausea and / or vomiting, 5% itching, no one with an infection. In the bupivacaine group, 25% noted nausea and / or vomiting, 5% itching, 5% infection. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. The overall satisfaction towards the intervention was high in 65% of patients receiving levobupivacaine, moderate in 30% and sufficient in 5%. Instead patients who received bupivacaine expressed 65% complete satisfaction and 35% satisfaction moderate. In neither of the two groups were found signs of toxicity by local anesthetic, such as tinnitus, pallor circumorale, cardiovascular or neurological manifestations. Finally, the last point on which we have focused our work has been the application of analgesic in post-operative period. Seventy percent of patients who received levobupivacaine required at least an analgesic (paracetamol) within twenty-four hours surgery and 30% required others analgesics. In the bupivacaine group, 60% took some paracetamol after twenty-four hours, 25% required other analgesics. The request for ananalgesic was slightly higher in patients receiving levobupivacaine.