Comparison of Hemodynamic Changes in Acute Intoxication with Intravenous Bupivacaine and Ropivacaine in Swine

Melo, Marcos De Simone; Silva, William Adalberto; Moraes, Ana Cristina de; Udelsmann, Artur

doi:10.1016/s0034-7094(09)70084-4

Cited by 4 publications

(5 citation statements)

References 29 publications

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“…Intravascular bupivacaine injection may result in severe toxicity of the central nervous and cardiovascular systems 4 which are the main targets. Damage to the nervous system precedes cardiac compromise with signs and symptoms including tinnitus, metallic taste, visual disturbance, perioral numbness, loss of consciousness, convulsions and death.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

et al. 2012

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PURPOSE:To evaluate the hemodynamic changes following SMOFlipid emulsion therapy with after bupivacaine intoxication in swines. METHODS: Large White pigs were anesthetized with thiopental, tracheal intubation was performed and mechanical ventilation was instituted. Hemodynamic variables were recorded with invasive pressure monitoring and pulmonary artery catheterization (Swan-Ganz catheter). After a 30-minute resting period, 5 mg.kg -1 of bupivacaine by intravenous injection was administered and new hemodynamic measures were performed 1 minute later; the animals were than randomly divided into two groups and received 4 ml.kg -1 of saline solution or 4 ml.kg -1 of SMOFlipid emulsion 20%. Hemodynamic changes were then re-evaluated at 5, 10, 15, 20 and 30 minutes. RESULTS: Bupivacaine intoxication caused fall in arterial blood pressure, cardiac index, ventricular systolic work index mainly and no important changes in vascular resistances. SMOFlipid emulsion therapy was able to improve blood pressure mainly by increasing vascular resistance since the cardiac index had no significant improvement in our study. Hemodynamic results of the use of lipid emulsion in bupivacaine intoxication were better than the control group. CONCLUSION: The SMOFlipid emulsion is a option for reversing hypotension in cases of intoxication by bupivacaine. Key words: Anesthesia, Local. Bupivacaine. Lipids. Hemodynamics. Fat Emulsions, Intravenous. Swine. RESUMO OBJETIVO:Avaliar as alterações hemodinâmicas da terapia lipídica com SMOFlipid após intoxicação com bupivacaína em suínos. MÉTODOS: Suínos da raça Large White foram anestesiados com tiopental, realizada intubação traqueal e mantidos em ventilação mecânica. As variáveis hemodinâmicas foram registradas através de pressão invasiva e cateterização da artéria pulmonar (cateter de Swan-Ganz). Após período de 30 minutos de repouso, 5 mg.kg -1 de bupivacaína foram injetados por via endovenosa e novas medidas hemodinâmicas foram realizadas 1 minuto após; os animais foram então aleatoriamente divididos em dois grupos e receberam 4 ml.kg -1 de solução salina ou 4 ml.kg -1 da emulsão tipo SMOFlipid a 20%. As alterações hemodinâmicas foram reavaliadas aos 5, 10, 15, 20 e 30 minutos. RESULTADOS: A intoxicação pela bupivacaína causou queda da pressão arterial, índice cardíaco e do trabalho sistólico dos ventrículos principalmente sem importantes alterações das resistências vasculares. A terapia com a emulsão SMOFlipid foi capaz de melhorar a pressão arterial através, principalmente, do aumento das resistências vasculares uma vez que o índice cardíaco não apresentou melhora expressiva em nosso estudo. Os resultados hemodinâmicos com o uso da emulsão lipídica na intoxicação pela bupivacaína foram melhores que no grupo controle. CONCLUSÃO: A emulsão SMOFlipid é uma opção para reverter a hipotensão em caso de intoxicação pela bupivacaína.

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Section: Introductionmentioning

confidence: 99%

Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

et al. 2012

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“…Animal studies have shown that bupivacaine results in a greater and more prolonged deleterious change in cardiac index, heart rate, and mean arterial pressure compared to ropivacaine. [ 19 ] Sub-group analysis studying the type of surgery and incidence of hypotension revealed a higher incidence in the bupivacaine group with mixed ‘author-defined’ surgeries (including lower abdominal, limb and gynaecology surgery), compared to the orthopaedic, major limb, arthroscopy and urology sub-group. [ 6 ] The reason could be that the required information size (IS) calculated using TSA was reached for the sub-group having mixed ‘author-defined’ surgeries including lower abdominal and limb/gynaecological procedures (n=324) compared to the orthopaedic/limb/arthroscopy sub-group (n=2414), thereby prompting us to conclude that more focussed RCTs are needed in the latter sub-group to conclude intrathecal ropivacaine's benefits over intrathecal bupivacaine for the latter sub-group.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal ropivacaine versus bupivacaine in a non-obstetric population- A meta-analysis and trial sequential analysis

Khalil,

Mehmud,

Banerjee

et al. 2024

Indian Journal of Anaesthesia

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Background and Aims: Intrathecal bupivacaine is used for anaesthesia and analgesia but is associated with hypotension. Ropivacaine is an alternative drug that may have fewer cardiotoxic and neurotoxic events. This meta-analysis investigated whether intrathecal ropivacaine is associated with reduced hypotension as compared to bupivacaine. Methods: The meta-analysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO). The databases PubMed, Cinahl Plus, Google Scholar, and Scopus were searched, and papers from January 1980 to January 2023 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. The primary outcome was the incidence of hypotension. Secondary outcomes were the duration of sensory block, duration of motor block, incidence of bradycardia, ephedrine usage, and duration of analgesia. Jadad scores were used to evaluate the quality of the papers. RevMan statistical software® utilised inverse variance and a random effect model to calculate the standardised mean difference with 95% confidence intervals for continuous variables and the Mantel–Haenszel test and the random effect model to calculate the odds ratio for dichotomous variables. Results: Thirty-three papers, including 2475 patients in total, were included. The Jadad score was between 1 and 5. The incidence of hypotension was significantly higher with intrathecal bupivacaine than with ropivacaine (P = 0.02). The duration of sensory block (P < 0.001) and motor block (P < 0.001) was prolonged with intrathecal bupivacaine. The duration of analgesia favoured intrathecal bupivacaine (P = 0.003). Conclusion: Intrathecal ropivacaine has a reduced incidence of hypotension and a reduced duration of sensory block compared to bupivacaine.

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“…Within this series, RVC has longer action than mepivacaine and is less toxic to the CNS/CVS than bupivacaine. Studies in pigs showed that RVC caused less hemodynamic repercussions than bupivacaine when equivalent doses were intravenously injected . Furthermore, studies in animals and humans suggest that RVC produces less motor block compared to bupivacaine, given its greater selectivity on the sensory nerve fibres, since it is synthesized and marketed in the S isomer form…”

Section: Introductionmentioning

confidence: 99%

“…Studies in pigs showed that RVC caused less hemodynamic repercussions than bupivacaine when equivalent doses were intravenously injected. [6] Furthermore, studies in animals and humans suggest that RVC produces less motor block compared to bupivacaine, given its greater selectivity on the sensory nerve fibres, [7] since it is synthesized and marketed in the S isomer form. [2] The use of sustained-release formulations has been proposed to improve solubility and bioavailability of low solubility anaesthetics, including systems based on cyclodextrins [8] and liposomal formulations.…”

Section: Introductionmentioning

confidence: 99%

Anaesthetic benefits of a ternary drug delivery system (Ropivacaine-in-Cyclodextrin-in-Liposomes): in-vitro and in-vivo evaluation

Vieira

Franz-Montan

Cabeça

et al. 2019

Journal of Pharmacy and Pharmacology

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Objectives To evaluate whether a ternary system composed of hydroxypropyl-bcyclodextrin (HP-bCD) further encapsulated into egg phosphatidylcholine liposomes (LUV) could prolong the action and reduce the toxicity of ropivacaine (RVC). Methods Dynamic light scattering and NMR were used to characterize the inclusion complex (RVC : HP-bCD), liposomal (RVC : LUV) and ternary (LUV : RVC : HP-bCD) systems containing 0.25% RVC. Their encapsulation efficiency, release kinetics, in-vitro cytotoxicity and in-vivo anaesthetic effect (paw-withdraw tests in mice) were also evaluated. Key findings 1 : 1 RVC : HP-bCD inclusion complex was encapsulated in liposomes (220.2 AE 20.3 nm size, polydispersity <0.25, zeta potentials = À31.7 AE 1.4 mV). NMR (diffusion-ordered spectroscopy (DOSY)) revealed stronger anaesthetic binding to LUV : RVC : HP-bCD (K a = 342 M À1 ) than to RVC : HP-bCD (K a = 128 M À1 ) or liposomal formulation (K a = 22 M À1 ). The formulations promoted in-vitro sustained drug release and partially reverted the cytotoxicity of RVC against 3T3 fibroblasts in the profile: LUV : RVC : HP-bCD ≥ RVC : HP-bCD > RVC : LUV. Accordingly, in-vivo sensory block of free RVC (180 min) was prolonged ca. 1.7 times with the ternary system and RVC : HP-bCD (300 min) and 1.3 times with RVC : LUV (240 min). Conclusions These results confirm the suitability of this double-carrier system in clinical practice, to decrease the toxicity and prolong the anaesthesia time evoked by RVC.

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Comparison of Hemodynamic Changes in Acute Intoxication with Intravenous Bupivacaine and Ropivacaine in Swine

Abstract: In swine, ropivacaine caused less hemodynamic repercussions than bupivacaine when the same doses were administered intravenously.

Cited by 4 publications

References 29 publications

Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

Intrathecal ropivacaine versus bupivacaine in a non-obstetric population- A meta-analysis and trial sequential analysis

Anaesthetic benefits of a ternary drug delivery system (Ropivacaine-in-Cyclodextrin-in-Liposomes): in-vitro and in-vivo evaluation

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