Cardiotoxicity of ropivacaine – a new amide local anaesthetic agent

Abstract

Anaesthetically equipotent doses of lidocaine, bupivacaine and a new bupivacaine-like local anaesthetic agent, ropivacaine, were injected into the left anterior descending coronary artery of pentobarbital-anaesthetized pigs. The aim was to study the cardiotoxicity of ropivacaine in relation to the two other drugs. A random, crossover, dose response study design was used. The following doses of the drugs were administered: lidocaine (L): 1,2,4,8 and 16 mg, bupivacaine (B): 0.25, 0.5, 1,2 and 4 mg and ropivacaine (R): 0.33, 0.66 1.33, 2.66 and 5.33 mg. Systemic haemodynamics, left ventricular dP/dT and a 12-lead electrocardiogram were recorded continuously during the study period. The drugs depressed cardiac contractility in relation to their local anaesthetic potency on the isolated nerve-4:3:1 (B:R:L). The prolongation of the ECG QRS-interval was regarded as a measure of electrophysiologic toxicity. Comparable prolongation of the QRS-interval was recorded after 2 mg of bupivacaine, 4.5 mg of ropivacaine and 30 mg of lidocaine. Thus, the electrophysiological toxicity ratio was 15:6.7:1 (B:R:L). Provided local anaesthetic potency data can be extrapolated from the isolated nerve preparation to regional anaesthesia in humans, ropivacaine appears to provide a greater margin of safety than bupivacaine, if inadvertently injected into the venous circulation.

The Effects of Local Anaesthetics on QT Parameters during Thoracic Epidural Anaesthesia Combined with General Anaesthesia: Ropivacaine versus Bupivacaine

“…Ropivacaine was less cardiotoxic than bupivacaine in terms of ventricular conduction, despite a 50% larger dose of ropivacaine in their study. In the study by Reiz et al (13), the cardiotoxicity of ropivacaine was evaluated compared with bupivacaine and lidocaine. The prolongation of the QRS interval was considered as Table 2.…”

Epidural ropivacaine hydrochloride during labour: protein binding, placental transfer and neonatal outcome

“…Its reported advantages over bupivacaine include reduced cardiotoxicity [3] and greater sensory blockade compared with motor blockade [4]. Acute changes in plasma AAG concentration during labour may alter the unbound fraction of ropivacaine, and thus its placental transfer.…”

Ropivacaína em bloqueio peridural torácico para cirurgia plástica

“…Isto é particularmente importante no caso da bupivacaína e parece ser responsável por casos de falên-cia circulatória relatados com este AL, mormente na área obstétrica 20,21 . A ropivacaína possui potencial cardiotóxico significativamente menor que o da bupivacaína 22,23 , o que diminui a possibilidade de falência circulatória pela somação de efeitos com o bloqueio simpático pela peridural. De qualquer maneira, ocorreram em quatro pacientes (6,6% dos casos) episódios de bradicardia com redução da FC a valores inferiores a 50 bpm, prontamente revertidos pela administração de atropina.…”

“…This is especially important with bupivacaine and seems to be responsible for circulatory failures reported with this LA, especially in obstetrics 20,21 . Ropivacaine is significantly less cardiotoxic than bupivacaine 22,23 , thus decreasing the chances for circulatory failure caused by the addition of effects with sympathetic block. However, there were 4 bradycardia episodes (6.6% of cases) with HR decreases to 50 bpm or less, promptly reverted with atropine.…”